FYI

Dentist blog from Delta Dental

Category: Clients (Page 1 of 2)

Stay up to date on coverage for large Delta Dental clients.

Medicare Advantage DHMO updates for 2022

It’s a new year, and that means there’s a new crop of partners joining Medicare Advantage. If you’re part of Delta Dental’s Medicare Advantage DHMO network, members of these groups with a Delta Dental Medicare Advantage DHMO plan can choose your practice as their primary care facility. If you don’t currently participate in this network, we still encourage you to review the following information.

Here’s a quick look at the new Medicare Advantage DHMO partners for 2022.

  • Bright Health covers approximately 7,500 members in Arizona, Illinois, Florida and New York.
  • Brand New Day has over 50,000 members throughout the state of California, from Placer and Sacramento counties in the north all the way down to San Diego and Imperial counties.
  • InterValley Health Plan serves about 17,000 members in the greater Los Angeles metropolitan area, with members in Los Angeles, Orange, Riverside and San Bernardino counties.
  • Western Health Advantage covers about 2,300 members in California’s wine country, including Marin, Napa, Sacramento, Solano, Sonoma and Yolo counties.

Additionally, the following Medicare Advantage partnerships are continuing in 2022. Some partners are making changes that may affect the coverage available to your patients. For partners who are updating their benefits, be sure to use Provider Tools to see details!

  • Central Health Medicare Plan in California has expanded to San Mateo County and enhanced their benefits for all divisions.
  • WellCare in California’s Orange and San Diego coverage is continuing DHMO coverage for its members.
  • SCAN Health Plan is expanding to San Mateo and Alameda counties in California.
  • Kaiser California Medicare is adding a new diagnostic and preventive benefit in California counties.
  • Kaiser Georgia Medicare is enhancing benefits and expanding to Newton, Rockdale, Spalding, Walton, Barrow and Butts counties in Georgia.
  • Stanford Healthcare Advantage in California is updating its website but making no changes to its DHMO offering at this time.

Nearly a million members nationwide have access to a Medicare Advantage plan through Delta Dental, and every day for the next decade, about 10,000 Americans will turn 65. By 2030, approximately 18% of the nation’s population will be 65 or older. Joining the Medicare Advantage DHMO network represents an incredible opportunity to expand your business by serving this growing market!

By joining the Medicare Advantage DHMO network, you’ll enjoy the following benefits:

  • Your practice will be listed in our Medicare Advantage network directory.
  • You’ll retain patients who are joining a Medicare Advantage plan. Their DHMO plans require that they visit Medicare Advantage network dentists.
  • You’ll grow your business with new Medicare Advantage patients looking for an in-network dentist.

Interested? To apply for participation in the Delta Dental Medicare Advantage DHMO network, please email medadv@delta.org. We’ll send you an application and contract.

Medicare Advantage PPO updates for 2022

It’s a new year, and that means there’s a new crop of partners joining Medicare Advantage. If you’re part of Delta Dental’s Medicare Advantage PPO network, you can see the members of these groups. And if you haven’t opted in, consider this: every year for the next decade, about 10,000 Americans will turn 65. By 2030, approximately 18% of the nation’s population will be 65 or older. Don’t miss out on the opportunity to expand your business by serving this growing market!

Here’s a quick look at the groups joining us for the first time and updating their plans this year.

  • Alignment Health Plan is a new group with approximately 2,500 members in northern and southern California. Members who choose expanded dental coverage can access the Delta Dental Medicare Advantage PPO network.
  • Aspire Health Plan is backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Healthcare System, bringing coverage to Monterey County in California. Beginning in 2022, certain diagnostic and preventive care benefits will be covered at 100%.
  • CDPHP Medicare serves the Capital Region in New York. In 2022, CDPHP will be expanding to St. Lawrence, Lewis and Jefferson counties.
  • CHRISTUS Health Plan offers Medicare Advantage dental coverage in the state of Texas and select areas of New Mexico.
  • Essence Healthcare serves members in the San Francisco Bay Area. Essence Healthcare was previously known as Stanford Healthcare Advantage.
  • Health Choice Utah offers coverage in all counties throughout the state of Utah.
  • Some Molina Healthcare states are moving outside of our network. In 2022, Delta Dental will be partnered with Molina Healthcare in California, Florida, Michigan, Texas and Wisconsin.
  • Select Health Advantage is available in Nevada in Clark and Nye counties.

Nearly a million members nationwide have access to a Medicare Advantage plan through Delta Dental. By joining the Medicare Advantage PPO network, you’ll enjoy the following benefits:

  • Your practice will be listed in our Medicare Advantage network directory
  • You’ll retain patients who are joining a Medicare Advantage plan. Their fee-for-service plans require that they visit Medicare Advantage network dentists.
  • You’ll grow your business with new Medicare Advantage patients looking for an in-network dentist.

Interested? To apply for participation in the Delta Dental Medicare Advantage PPO network, please email medadv@delta.org. We’ll send you an application and contract.

Medicare Advantage updates for 2021

For 2021, Delta Dental will welcome a new Medicare Advantage partner, and several other partners will update their offerings.

  • Astiva Health Plan: A new partner for 2021, this DHMO Medicare plan has 1,500 members in California’s Orange and San Diego Counties.
  • AvMed: This Miami, Florida-based partner will offer two new DHMO plans in addition to the current plan. The new Basic Plus adds periodontal services to the current plan. The Comprehensive plan provides rich benefits that include implant services.
  • Chinese Community Health Plan: CCHP will offer two new plans to their membership in San Francisco, the preventive-only plan (mandatory with medical coverage) and a Medi-Medi wrap plan, which will enhance member Medicaid benefits. This California group is increasing to 5,000 members with the addition of these two plans.
  • Hometown Health: In northern Nevada, a new preventive-only plan will join the two current options currently available. In southern Nevada, the comprehensive plan will replace the preventive plan. All dental plans are mandatory for 2021, which adds 7,000 members to our partnership.
  • Memorial Hermann: This Texas partner will introduce Memorial Hermann Advantage Plus, a mandatory comprehensive PPO plan. The current Memorial Hermann Advantage plan is a DHMO product.
  • Molina Healthcare: This partner offers plans in California, Florida, Idaho, Michigan, New Mexico, Ohio, South Carolina, Texas, Utah, Washington and Wisconsin. While there are no changes to the current plan design in these states, there are increases in the annual maximum for several markets. New for 2021 are wrap plans in Idaho and South Carolina, in which Medicare benefits enhance Medicaid benefits.

Are you part of our Medicare Advantage dentist network? If you haven’t opted in, consider this: Every day for the next decade, about 10,000 people will turn 65. And by 2030, approximately 18% of the nation’s population will be 65 or older, according to Pew Research Center population projections.

Today, nearly a million people nationwide have a Medicare Advantage plan through Delta Dental. And as Medicare Advantage plans continue to expand, your practice has a great opportunity to find new patients.

The advantages of joining our Medicare Advantage dentist network include:

  • Your practice will be listed in our Medicare Advantage network directory
  • You’ll retain current Medicare Advantage patients, whose fee-for-service plans require that they visit a Medicare Advantage network dentist
  • You’ll acquire new Medicare Advantage patients looking for an in-network dentist

Interested? To apply for participation in the Delta Dental Medicare Advantage provider network, please send an email to medadv@delta.org and we’ll reply with an application and contract.

Changes for Bayer patients

The Bayer Corporation recently acquired Monsanto Company. As of Jan. 1, 2019, Monsanto employees and their covered dependents, approximately 15,000 patients, will be covered under Bayer’s dental plan.

Bayer is also expanding its plan options. Employees and their covered dependents can choose from two Delta Dental PPO™ plans: Basic and Comprehensive. If a patient has been diagnosed with diabetes, cardiovascular (heart) disease, HIV/AIDS, rheumatoid arthritis or cerebrovascular disease (stroke), he or she can opt in to SmileWay Wellness Benefits for expanded coverage.

These plans are administered by Delta Dental of Pennsylvania. Claims should be sent to the following address:

Delta Dental of Pennsylvania
P.O. Box 2105
Mechanicsburg, PA 17055-6999

To speak to a Customer Service representative, call 800-932-0783 toll-free, Monday through Friday, 8 am to 9 pm Eastern time.

Intel patients have risk-based benefit

Intel Corporation adopted a risk-based approach to dental care on January 1, 2018. Its Delta Dental PPO™ plan (group #05178) includes the following per calendar year for your Intel patients:

  • One exam for adults at low risk for oral health problems
  • Two exams for children to age 14 and high-risk adults, including those who have had restorative, endodontic or periodontal treatment within the last three years
  • Either two cleanings or up to four cleanings for patients with certain periodontal or chronic conditions

Log in and use Provider Tools to review detailed benefits information, treatment history and claim status.

Intel moving to risk-based benefit

Intel Corporation is implementing a risk-based approach to dental care. Starting January 1, 2018, its Delta Dental PPOSM plan will cover one exam per calendar year for adults at low risk for oral health problems.

Two exams per calendar year will be covered for children to age 14 and high-risk adults, including those who have had restorative, endodontic or periodontal treatment within the last three years. If we receive a claim for a second annual exam, we’ll check the patient’s treatment history to determine risk level and apply the appropriate benefit.

Your Intel patients will continue to be covered for either two annual cleanings or up to four cleanings for patients with certain periodontal or chronic conditions.

Log in at deltadentalins.com and use Provider Tools for:

  • Detailed benefits information (“My Patients” or “Eligibility & Benefits”)
  • Services provided for the patient on claims we’ve processed from any dentist (“Treatment History”)
  • Free real-time claims (“Submit Claim”)
    • Intel group number: 05178
    • Payer number for electronic claims and pre-treatment estimates: 77777
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