Understand the difference between what is covered and what is needed. Consult with your provider prior to beginning any treatment. A retiree plan and a spouses active plan: Usually, the patients retiree plan is primary (a persons own coverage is primary for himself/herself); however, check the Evidence of Coverage for the retiree plan there may be a provision making it secondary to an active plan. Smiles For Children (SFC) pregnant individuals enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older 600 East Broad StreetRichmondVirginia. Charges for clear aligners (e.g., Invisalign, SureSmile) should be submitted using theappropriate orthodontic procedure code (D8010-D8090). (1) Network Fee: This fee represents what most dental service providers M-T 8:30a-10p | F 8:30a-9p | Sat 9a-6p | Sun 10a-4p EST. This website shows estimates of certain dental care costs. To get a list of participating specialists in your patients' area, call DASI at 800-524-0149, or use our online . Delta Dental Premierand Delta Dental PPO Claims. The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan. The Disposable Dental Supplies - Single Use Products | If the claim does not have this field, please list each item on a separate line. . Cosmetic Dentistry: Teeth Whitening & Alignment | Generally, Delta Dental allows one reevaluation per claim. PO Box 537007 . Use Provider Tools forfreereal-time claims with digital attachments and pre-treatment estimates. The AMA does not directly or indirectly practice medicine or dispense medical services. D7410D7415, D7440D7461, D7465, Description of service: Dental Office Dcor Reception Room Furniture | D3310-D3330, D3921. By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. Delta Dental of California and Affiliates is a part of Delta Dental Plans Association. When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patients most current eligibility and benefits to determine payment. * All pre-treatment radiographs, photographs and charting should be within 12 months of the planned treatment unless otherwise specified. The data is based on actual, non-discounted charges that providers have billed. Box 9304 . To be sure, please refer to your dentist handbook. Unfortunately, we cannot provide pre-treatment estimates by telephone. AARP Dental Insurance Plan c/o Delta Dental Insurance Company If you are experiencing a medical or dental emergency, you should seek appropriate emergency medical or dental assistance, such as calling "911." Your actual cost may be higher or lower than the estimate for various reasons. Balance your fees before negotiating your PPO reimbursement contracts. Customers can upgrade any fee analysis to a complete Henry Schein Practice Analysis for an additional $99 per zip code. Find out more about how this website uses cookies to enhance your browsing experience. How will the NPI affect other numbers I've used in the past? Depending on the state, maximum contract allowances are derived from a variety of factors, including data from fees on claims, fee filings submitted by dentists (not applicable for Delta Dental of Pennsylvania), current economic factors and/or other data. For extensive or unusual services, what would you need to understand why a patient needs a particular treatment? Health information changes quickly. Daniel Ribeiro , Dentist has not yet indicated the hospitals that he is affiliated with. Your National Provider Identifier (NPI) is an important number for all providers to have in order to successfully submit claims with Delta Dental. Dental coverage is now available for adults! Checking the patients Evidence of Coverage for both plans will help you determine when a medical plan is primary. Dental Reminder Postcards and Filing Office Supplies | Note not all plans and During clinical review of claims and pre-treatment estimates, Delta Dental reserves the right to request radiographic images and/or documentation for procedures that otherwise may be identied as not requiring the submission of documentation. MEMBER FEE SCHEDULE MEMBER PAYS DENTAL SERVICE (Maximum Charge) Delta Dental of Illinois DDIL.PD.FS.0802 Diagnostic Services D 0120 Periodic oral evaluation $23 D 0140 Limited oral evaluation-problem focused $34 . The Dental Care Cost Estimator sometimes groups together, into "treatment categories," services that are often delivered together to address a particular dental problem. My Contracted Fees 1. The national network of Delta Dental companies protects more smiles than any other insurance company. Mailed applications may require up to 20 days to process. plan booklet for complete plan details. Its just not a payable claim under the terms of the dental benefit contract. We encourage you to check with your participating provider prior No. Massachusetts dentists have a few options: Mail: Provider Enrollment and Credentialing Department (PEC) at Delta Dental of Mass. The amount that would have been payable by Delta Dental may not be charged to the patient. Looking to cover yourself or your family? Alpharetta, GA 30023. The secure version (available only after you sign in) uses procedure costs or cost ranges as reflected in provider fee schedules and aggregated historical cost data. If you enter two NPIs (one for the treating dentist and another for the billing entity), please verify that they are both valid. Dental consultants look for reasons to approve your claims. Dental Handpieces & Dental Handpiece Repair | Example:If you provide treatment for erosion, theres a good chance the claim cannot be paid because erosion is a common exclusion under most dental plans. Simply submitting it on a claim will not ensure that it's entered into the Delta Dental system. For more detailed information on your dental care costs, please consult your dentist or your Delta Dental. Look Up a ZIP Code. MHCP Fee Schedule (MHCP Fee Schedule (dental codes begin on page 55 of the PDF) Fraud, Waste, and Abuse: Combating Medicare Parts C and D Fraud, Waste and Abuse Training Web Based Training Course 2022; In this case, the secondary carrier would pay $14 ($80 x 80% - $50 = $14). We strongly recommend that you confirm that a provider is currently participating before you receive any services from that provider. Dental Office Supplies & Essentials | By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. whose birth date is earlier in the year provides primary coverage. You should always talk to your health care professionals for information concerning diagnosis and treatment, including information regarding which drugs or treatment may be appropriate for you. App features may vary by geographic area and individual dentist participation. Lack of sufficient information, especially themembers ID number, is the most common reason for a delayed or denied claim. For joint custody, the plan that has covered either stepparent longest provides primary coverage. Savings plans are NOT insurance and the savings will vary by provider, plan and Resources. . A pretreatment If you . Implant supported prosthetics, Description of service: After confirmation of the receipt of your application, you should receive your NPI via e-mail within one to five business days if you submitted the application online. Since Example:If you submit a claim for a crown that was placed to restore a tooth with a fractured cusp, be sure the fractured cusp is visible in the x-ray copy. A spouse or domestic partners plan is secondary. Start quoting dental + vision plans for small business. Include all patient information on claims. %PDF-1.6 % For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental. For more information about electronic encounter form submission, please email ourEncounters department. For example, allowances for Delta Dental PPO are different in most cases from those for the Delta Dental Premierplan. These listings are updated on a regular basis, and every effort has been made to ensure that only participating active providers are listed. Confidential Filed Fee Schedule E-mail:customerservice@npienumerator.com, Telephone:800-465-3203 / 800-692-2326 (NPI TTY), Mail:NPI Enumerator Receiving prompt notification of any invalid data, allowing you to make the necessary corrections and re-submit right away. Delta Dental network dentists are paid directly when they treat Delta Dental members, and our quick, accurate claims processing - ensures you'll be paid promptly and easily. Member perks for your smile and beyond The Content on this website is not medical advice. Box 1826, Alpharetta, GA 30023. None of the information on this website represents or warrants that any particular drug or treatment is safe, appropriate or effective for you. The national network of Delta Dental companies protects more smiles than any other insurance company. Sitemap - Henry Schein Dental. Fax: 717-774-1770 The SFC program is managed by Dentaquest. The NPI Enumerator will help you with your NPI application and to update your information in the NPPES. If you are unsure of your dentists zip code, you may enter your home zip code. Please make sure we have your correct Tax Identification Number (TIN) on file to facilitate correct payment. Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patients: At any time, you can review the patients current eligibility and benefits information, including remaining maximum and deductible amounts. If you live outside the U.S., you may see information on this cost estimator about products or services that are not available or authorized in your country. Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah and U.S. Virgin Islands: E-mail:ProfessionalServices@ddic.delta.org P.O. The procedures discounted under these plans and programs offer similar savings to the sample above. Miscellaneous services. Box 2105 Special promotions including, but not limited to, additional months free are not available out additional fee information on common procedures in your area, the process is Contact your company's human resources department. Dental Staff Education | DentalPlans detailed profile of Roshanak Rastegar , DDS - Dentist in 20152. This causes the dental carrier to cover the patient's share of the fee. Here are the benefits of creating an account. Dental Lab Coats | All of those matters are things that you should decide, in consultation with your dental care professionals. Delta Dental may also terminate the dentists participation agreement if a dentist regularly waives patient copayments. More Information On Dental Supplies | Dental coverage is now available for adults! Connect with your Delta Dental company to learn more. PO Box 1809 You can submit a request for a claimadjustment. Check out Virtual Consult, Check out our new DeltaVision plans Maximum contract allowances will differ by 5-digit ZIP code. Be sure to enter the treating dentists license number or National Provider Identifier (NPI). Here are some suggestions to speed up claim payments. Confidential Filed Fee Schedule (Updated to include CDT 2015 code terminology) Statement of Intent: I agree that each fee submitted to Delta Dental on a claim for dental services I provide to any Delta Dental patient will be . To check that your provider participates, visit our website or call us. 4. This is important because some services may be included in the patients basic coverage, even if the patient does not have specific orthodontic coverage. Find the claim number you wish to adjust and choose "Submit a request" in the Claim adjustment section. Do you submit claims attachments electronically? Estimates should not be construed as financial or medical advice. However, some programs may require you to submit claims within a shorter period of time (e.g., 90 days for Texas CHIP program). Dental Materials: Dental Equipment & Technology | We do not return radiographic images or other documentation submitted with paper claims; however, we will make an exception when we receive a stamped, self-addressed envelope with the claim. Dual coveragerefers to when a patient's dental treatment is covered by more than one dental benefits plan. The Content on this website is not medical advice. Dental Forceps & Extraction Tools | Refer to your benefit plan to determine whether these requirements apply to you. The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what services your dental benefits plan will cover or your out-of-pocket costs. Estimates should not be construed as financial or medical advice. Mailing addresses for your Delta Dental Premier and Delta Dental PPO claims. These updates are required to be filed first for approval by state regulatory agencies in many locales. Dental Equipment Sales & Services | Listerine Ultra Clean Floss | P.O. From a cleaning and an X-ray, to a crown or a root canal, the tools lets subscribers search by ZIP code and dentist to find the best price by procedure. Be sure to submit dual coverage information on claims for orthodontic procedures, even if the other insurance does not cover orthodontics. The costs provided in this tool are estimates only and are not a guarantee of payment or benefits. Enter your patients name and choose Existing (or enter a new patients information). Want to know before you set foot in the dentists office? 118 0 obj <> endobj The sample table is a small selection of common procedures discounted by these discount dental plans and programs.