FYI

Dentist blog from Delta Dental

Tag: claims (Page 1 of 2)

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.

Use Provider Tools to submit claims, get answers to your questions

Necessary changes in Delta Dental’s operating practices are directly impacting our processing of paper claims and paper checks, as well as answering customer calls. Using Provider Tools is the quickest, easiest way to get your claims processed, checks paid and questions answered.

  • Submit real-time claims electronically for faster processing and payment, for free.
  • Sign up for direct deposit.
  • Check patient eligibility and benefits.
  • Check claim status and treatment history.
  • Find answers to your questions about fees, benefits, eligibility and pre-treatment estimates.

If you don’t already have a Provider Tools account, it’s free and easy to register.

Need help with registration? Read our handy registration guide. Additionally, we have Provider Tools tutorials (see “Resources” tab), including videos and articles with step-by-step instructions on claims submission, eligibility, benefits, direct deposit and more.

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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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 PPOTM 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.

Go nationwide with “National Search”

Do you have patients with Delta Dental plans from all over the map? Or, are you sometimes unsure about which Delta Dental company covers a new patient? There’s help! Simply log in at deltadentalins.com and select “National Search.” Enter the patient’s ID, name and birth date to get eligibility, benefits and claims history from any of the 39 Delta Dental member companies.

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