FYI

Dentist blog from Delta Dental

Category: Policies (Page 1 of 3)

Processing policies, contracts, fees, CDT codes, ICD-10, re-credentialing

Processing policy changes in response to COVID-19

To help keep you and your patients safe during the COVID-19 pandemic, we are implementing temporary changes to our processing policy. These changes allow you more options to reduce the spread of infection in your dental practice.

These modifications will be in place until November 30, 2020.

Exceptions for periodontal scaling and root planing (SRP)

Delta Dental’s current policy is that no more than two quadrants of scaling and root planing are benefited on the same date of service in the absence of supporting documentation.

Effective immediately, Delta Dental will consider concerns regarding exposure to COVID-19 as a valid clinical reason to perform more than two quadrants of scaling and root planing on the same date of service.

As always, radiographs and a copy of the patient treatment record (clinical progress notes) are required if more than two quadrants of scaling and root planing are performed on the same date of service.   

Radiographic images for restorative procedures

Radiographic images are required when submitting for crowns, fixed partial dentures and scaling and root planing. Periapical radiographic images depicting the apex are preferable when submitting for crowns and fixed partial dentures.

To avoid the need for additional visits and limit staff and patient exposure, Delta Dental will accept diagnostic panoramic images when submitting for these services.  

Periodontal chart

A periodontal chart is necessary for scaling and root planing and periodontal surgery procedures. Under Delta Dental’s clinical guidelines, a current periodontal chart is one that is taken no more than 12 months prior to the date of service.

To reduce the need for staff exposure and additional appointments, Delta Dental will now accept a periodontal chart that is taken no more than 15 months prior to the date of service.

Receive Return to Care supplemental reimbursement

The COVID-19 pandemic has affected dental practices across the country. To help you deliver valuable care to your patients, Delta Dental is temporarily offering a $10 supplemental reimbursement for each qualifying evaluation or consultation code, starting June 22, 2020 and ending October 20, 2020.

Am I eligible?

To receive the Return to Care reimbursement, you must participate in one of the following networks and treat an eligible patient covered by one of these Delta Dental plans:

  • DeltaCare® USA
  • Delta Dental PPO™ and DPO in Texas (see applicable Delta Dental companies below)
  • Delta Dental Premier® (see applicable Delta Dental companies below)
  • Delta Dental Federal (Legion), Medicare Advantage

Applicable Delta Dental companies include Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of the District of Columbia, Delta Dental of Delaware, Inc., Delta Dental of West Virginia, Inc. and Delta Dental of New York, Inc.

The Medi-Cal Dental, CDPHP (NY Medicaid) and HSCSN (Washington, D.C. Medicaid) networks are not eligible for this reimbursement.

How do I receive the reimbursement?

If you’re a DeltaCare USA dentist with a capitation agreement, simply submit your DeltaCare USA encounter form when you treat a DeltaCare USA enrollee. We’ll add $10 to the encounter fee during processing.

For other dentist networks (including DeltaCare USA dentists without capitation agreements), the reimbursement will be provided when you submit a claim for any of the following evaluation or consultation codes:

  • D0120
  • D0140
  • D0145
  • D0150
  • D0160
  • D0170
  • D0180
  • D0190
  • D0191
  • D8660
  • D9310
  • D9430

Please submit your usual office fee rather than your contracted fee.

Any charge for sterilization or infection control is not billable under any Delta Dental plan and cannot be charged to the patient.

Can I use procedure code D1999 to charge a separate fee for personal protective equipment (PPE)?

No, personal protective equipment is considered part of the delivery of care and not separately billable. Additionally, the patient may not be charged.

You cannot submit code D1999 to receive the temporary supplemental reimbursement.

What if I don’t perform an evaluation or consultation at every visit? Can I receive the reimbursement for other submitted procedure codes?

No. Only these 12 qualifying CDT codes are eligible for the supplemental reimbursement: D0120, D0140, D0145, D0150, D0160, D0170, D0180, D0190, D0191, D8660, D9310 and D9430.

Will frequency limitations still apply for evaluation and consultation codes?

Yes, the specific plan benefits and frequency limitations will apply. If a patient exceeds the frequency limitation or has exceeded the plan maximum for one of the qualifying CDT codes, the patient will be responsible for the allowed amount, which will include the temporary supplemental reimbursement.

I still have questions. How do I get more information?

If you’re a DeltaCare USA, PPO or Premier dentist, email your questions to providerconcierge@delta.org. If you participate in Federal Programs (Legion), email FSPS@delta.org.

Use teledentistry to assess patients while sheltering in place

In light of the American Dental Association’s recommendation to postpone elective care, please use teledentistry to assess patients for non-emergency consultations and emergency diagnoses.

Delta Dental will accept claims for teledentistry services. Please submit the claim for your patient interaction using the appropriate evaluation procedure code, such as D0140, D0170 or D0171. On a separate line, also submit teledentistry code D9995 for real-time interactions (synchronous) and D9996 for text, photo or other non-live interactions (asynchronous) D0170, D0171.

Fees for teledentistry (D9995 and D9996) are considered inclusive in overall patient management and are not billable to the patient. Standard dental policy will apply to the evaluation codes.

For more details, please visit our COVID-19 resources for dentists. Once again, thank you for the work you do and as you guard our collective health.

How to protect your practice during COVID-19

The safety and continued success of our providers is of utmost importance to us. To that end, here are several ways you can better protect yourself, your staff, your business and your patients during the COVID-19 (coronavirus) pandemic.

For the latest updates, please visit our COVID-19 resources page for providers, which includes links to the Centers for Disease Control and Prevention’s COVID-19 guidelines, as well as additional guidelines provided by the ADA. Thank you for supporting both individual health and public safety.

Take a look at CDT 2020 updates

The American Dental Association’s CDT procedure codes and nomenclature* have been updated for 2020. Changes include 37 new codes, six code deletions and several nomenclature and description revisions.

Please review our summary of changes and updated Delta Dental claims processing policies and begin using CDT 2020 codes on claims for procedures provided on and after Jan. 1, 2020.

*CDT coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.

View the PDF summary of CDT 2020 changes.

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Informed consent is key to patient satisfaction

Ensuring that patients understand their financial responsibility for treatment, including treatment that is not covered under their dental benefits plan, can help safeguard their overall satisfaction with your practice.

A good way to accomplish “informed consent” (as required under your Delta Dental participation agreement) is with a thorough discussion about treatment, alternatives and costs, along with a form or other documentation that includes the same information and the patient’s written acknowledgement of the discussion. Points to discuss and document include:

  • The agreed-upon course of treatment and specific non-covered services
  • The patient’s acknowledgement of non-covered services and personal responsibility for the cost
  • Risks and advantages of proposed and alternative treatment
  • Costs for necessary subsequent treatment, such as a crown after endodontic therapy

In addition, we strongly recommend that you submit a pre-treatment estimate before providing any non-covered services (or any expensive and/or extensive services). Though not usually required, a pre-treatment estimate has several advantages, including further helping patients understand their benefits and financial obligations.

Much of this information is covered in your Dentist Handbook, which is updated periodically. Be sure to review it regularly by logging in and using the Reference Library.

 

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