Subscribers and Members
Brokers and Consultants
|1.||Who is eligible to become a Delta Dental participating dentist?|
|2.||What is the purpose of a Participating Dentist Agreement?|
|3.||How does Delta Dental determine the dentist's reimbursement level?|
|4.||Does Delta Dental require credentialing?|
|5.||I'm interested. How do I contact Delta Dental?|
|6.||How should I submit procedures that are being done for cosmetic purposes?|
|The following questions relate to claims history on the Web site.|
|7.||Where can I find claims history information on the Delta Dental of Minnesota Web site?|
|8.||Some employers provide more detailed information than others. Why?|
|9.||Where can I find the dates a patient is eligible for benefits for a procedure?|
|10.||Where is the patient’s address displayed on the Web?|
|11.||Where is the claims processing address displayed on the Web site?|
|12.||Is waiting period information available on the Web site?|
|13.||Is a listing of reason denial codes available on the Web site?|
|The following questions relate to 835/Electronic Remittance Advice.|
|14.||What is an 835/Electronic Remittance Advice (ERA)?|
|15.||How will I receive the 835/ERA?|
|16.||How will this be loaded into my Practice Management System?|
|17.||Will I be charged for the 835/ERA?|
|18.||Can I still receive paper?|
|19.||Will the 835/ERA differ from paper?|
|20.||Can I discontinue the paper EOBs I receive?|
1. Who is eligible to become a Delta Dental participating dentist?
Any dentist licensed under the laws of any state in the United States is encouraged to become a Delta Dental participating dentist.
2. What is the purpose of a Participating Dentist Agreement?
Through the Participating Dentist Agreement, Delta Dental and the dentist work together to provide affordable dental care. While each Delta Dental network has its own unique agreement, some of the common agreement provisions include:
7. Where can I find claims history information on the Delta Dental of Minnesota Web site?
To find information on claims submitted by your office, on the left side of any Web page click on Dentist and select Sign In. Set up a new user account or sign in using your username and password.
Once inside the application, from the Menu page click Subscriber Search and enter your patient’s subscriber ID and date of birth to receive the Coverage Summary page. In the upper right side of the screen you will see a link to Claims Inquiry. On the Claims Inquiry page, click the patient’s name to see a history of claims and procedures we’ve processed from your office.
Please note that you will only have access to claims history information from your office.
8. Some employers provide more detailed information than others. Why?
We want the information we post on the web to be as accurate as possible. However, because benefits can vary so much between groups, we sometimes need to generalize to remain accurate.
9. Where can I find the dates a patient is eligible for benefits for a procedure?
Please note that not all group benefits can be displayed on the web.
To access this information, on the top of any Web page click on Dental Professionals under Login to your Account. Set up a new user account or sign in using your username and password.
Once inside the application, from the Menu page click Subscriber Search and enter your patient’s subscriber ID and date of birth to receive the Coverage Summary page. If the subscriber's benefits can be displayed on the Web, in the middle on the right side of Coverage Summary you will see a column for Benefits Inquiry. Click the View link.
Once inside the Benefits Inquiry application, select Frequency Limits for Common Services. Here you will find a chart of common procedure codes and billable frequencies. View the patient’s claim history to determine whether he or she is eligible to receive the procedure.
10. Where is the patient’s address displayed on the Web?
The patient’s address is HIPAA-protected information, and therefore is not displayed on our Web site.
11. Where is the claims processing address displayed on the Web site?
To find helpful contact information for a variety of questions, please go to the Contact Us link on any Web page to view phone and address information.
12. Is waiting period information available on the Web site?
Not at this time.
13. Is a listing of reason denial codes available on the Web site?
Not at this time.
14. What is an 835/Electronic Remittance Advice (ERA)?
The 835/Electronic Remittance Advice is an electronic version of the provider Explanation of Benefits (EOB).
15. How will I receive the 835/ERA?
This will be sent to you by the same clearinghouse that you submit your electronic claims to.
16. How will this be loaded into my Practice Management System?
Check with your software vendor to see what capabilities they offer. Some software vendors have the capability of automatically posting this data directly into your accounts receivables. Others may only provide a display image that can be printed and would need to be manually entered.
17. Will I be charged for the 835/ERA?
Check with your clearinghouse and software vendor to determine what, if any, cost there may be for you. Delta Dental of Minnesota does not charge a fee for the 835/ERA.
18. Can I still receive paper?
If you are a Minnesota provider, you must comply with the MN Statute 62J requiring all provider EOBs be electronic. If you need duplicate EOBs, you can obtain a copy by visiting our Web site at http://www.deltadentalmn.org / and going to the Claims Inquiry application. You can also contact Customer Service at 1-800-328-1188.
19. Will the 835/ERA differ from paper?
In most areas, the 835/ERA supplies additional information which aids in the automatic posting process. However, the processing policies are more general than what is currently on the paper EOB. If you have trouble with interpreting the processing policies, you can refer to the member’s ID card for information to contact Customer Service or a reference to a Web site for access to view the claim online.
20. Can I discontinue the paper EOBs I receive?
Yes, for providers based in Minnesota, please contact Delta Dental of Minnesota in writing to request that the paper EOBs be discontinued. This request should be sent to Professional Services at PO Box 9304, Mpls., MN 55440-9304.