Network Descriptions

Delta Dental Premier Network
Delta Dental Premier National Network
Delta Dental PPO Network
Delta Dental PPO National Network
State of Minnesota (State Dental Plan/Group 216) Network
CivicSmiles Network

Delta Dental Premier® Network
Delta Dental Premier is our largest fee-for-service network and most widely purchased program. Dentists in this network provide dental care to plan subscribers who participate in Comprehensive Standard, Comprehensive Enhanced, Preventive, Basic, Dental Flex and national dental benefit plans. In Minnesota, Delta Dental Premier has more than 3,060 participating dentists. Advantages of becoming a Delta Dental Premier dentist include:
  • Access to the 3.8 million Delta Dental of Minnesota members nationwide who enjoy Delta Dental coverage through employee group programs
  • Automatic participation in the national network
  • Payment of claims issued directly to you instead of to the plan subscriber
  • Great marketing opportunity. Your name or practice name, phone number and address are listed in the directory available to plan subscribers, as well as online in our interactive Dentist Search
  • Online access to eligibility and claims information
Dentist Participation Requirements
Any dentist licensed under the laws of any state in the United States is encouraged to become a Delta Dental Premier participating dentist. Dentists interested in participating in the network must complete the following information:
  • Delta Dental Premier Membership and Participation Dentist Agreement
  • Dentist and Facility Credentialing
  • Specialty Declaration
  • Current Confidential Fee Schedule
  • W-9 Taxpayer Identification Number
  • Statement of Dentist Consent
  • Signature On File

Network Dentist Reimbursement
Payment of the dental plan is made directly to the participating dentist. The plan's payment is based on the allowed amount after deductibles and coinsurance. The allowed amount is determined by taking the lesser of the submitted amount, the dentists' pre-filed fee allowance, and the maximum fee for the particular procedure code. Delta Dental of Minnesota participating dentists accept the allowed amount as payment in full for services covered under the plan.

To speak with a Network Services Representative about participation in the Delta Dental Premier network, call 651-406-5900 ext. 4170 or 1-800-328-1188 ext. 4170.

Delta Dental Premier National Network
Delta Dental offers programs to national account groups. Delta Dental Premier is the largest dental network in the country with more than 142,000 participating dentists. See if your office listing is current.

Delta Dental PPOSM Network

In Minnesota, Delta Dental PPO has approximately 1,788 participating dentists. This network is available to any employer group looking for an alternative to our traditional fee-for-service dental program. It offers additional cost savings to employer groups with options for enhanced benefits and a greater fee discount to plan members who choose a Delta Dental PPO network dentist. Participating in Delta Dental PPO in Minnesota includes automatic participation in the Delta Dental PPO National participating dentist network.

Participation in the Delta Dental PPO network requires an additional agreement between Delta Dental and the dentist. The agreement states that the participating dentist will accept payments based on the Delta Dental PPO fee maximum, which is discounted, rather than Delta Dental's standard reimbursement. Subscribers of either option will have an employee ID card that identifies the subscriber as participating in the plan. Participation in Delta Dental PPO also automatically enrolls the dentist in the national network.

Dentist Participation Requirements
Dentists interested in participating in the Delta Dental PPO network must also participate in the Delta Dental Premier network. They must sign a Delta Dental PPO network dentist agreement.

Network Dentist Reimbursement
Payment of the dental plan is made directly to the participating dentist. The plan's payment is based on the allowed amount after deductibles and coinsurance. The allowed amount is determined by taking the lesser of the submitted amount, the dentists' pre-filed fee allowance, and the Delta Dental PPO maximum allowable fee table. Delta Dental PPO dentists accept this reimbursement as payment in full for services covered under the plan.

To speak with a network Services Representative about participation in the Delta Dental PPO network, call 651-406-5900 ext. 4170 or 1-800-328-1188 ext. 4170.

Delta Dental PPO National Network

Delta Dental PPO is our national PPO network with more than 83,900 participating dentists practicing in 168,000 locations. See if your office listing is current.

State of Minnesota (State Dental Plan/Group 216) Network

The State of Minnesota offers employees a special dental benefit plan administered by Delta Dental of Minnesota. This plan is designed specifically for State of Minnesota employees and their families located throughout Minnesota. State of Minnesota subscribers carry unique ID cards bearing their name and group number (216).

Dentist Participation Requirements
Dentists interested in participating in the State of Minnesota PPO network must also participate in the Delta Dental Premier network. They must sign a State of Minnesota network dentist agreement.

Minnesota's Rule 101 requires dentists who receive reimbursement for dental care services rendered to State of Minnesota, county or city employees also accept up to 10 percent of Minnesota Health Care Program recipients as active patient encounters in their dental office. This is a State Rule, not a Delta Dental requirement. Participation in the CivicSmiles Network, Minnesota Department of Human Services fee-for-service program, a Managed Care Organization or other networks that serve members of Minnesota Health Care Programs will count toward the requirement as defined by Rule 101.

Network Dentist Reimbursement
Dentists who participate in the State Dental Plan network receive payment directly. The plan's payment is based on the allowed amount after deductibles and coinsurance. The allowed amount is determined by taking the lesser of the submitted amount, the dentists' pre-filed fee allowance or the maximum fee allowable for the procedure code. Maximum fees for the State Dental Plan are determined by the State of Minnesota. A dentist who participates in the State Dental Plan network accepts the allowed amount as payment in full for services covered under the plan.

To speak with a Network Services Representative about participation in the State Dental Plan network, call 651-406-5900 ext. 4170 or 1-800-328-1188 ext. 4170.

CivicSmilesSM Network  
One network – two purposes. The first is to serve Minnesota Health Care Program recipients who have chosen a Managed Care Plan. The second is to serve Medicare recipients who have purchased dental benefits through Medicare Advantage or Medicare Fee-For-Service programs.

Delta Dental of Minnesota (Delta Dental) administers dental benefits for several health plans under contract to serve Minnesota Health Care Programs (MHCP) recipients. Delta Dental offers a separate network contract for dentists or clinics that serve patients under the health plan contracts. This network serves individuals who are eligible for enrollment through the health plans.

A Health Plan's contract with Department of Human Services (DHS) determines the service area for MHCP. Not all health plans are offered in each county. In most instances, the health plan will be serving populations including, but not limited to: Medical Assistance (MA), General Assistance Medical Care (GAMC), Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus (MSCplus), Special Needs Basic Care (SNBC) and MinnesotaCare.

The Medicare programs served by CivicSmiles are dental benefits purchased by Medicare eligible people enrolled in a Medicare Advantage or Medicare Fee-For-Service program. This is not the same group of people that are enrolled in MSHO or MSCplus. The service area is statewide for the Medicare programs.

Rule 101
Participation in this network fulfills the requirement set up under Minnesota Law that is administered by the DHS and Department of Employee Relations (DOER). The Rule states that if the dentist serves State, County, City, Municipal or University employees, the dentists must also agree to see MHCP patients.

In order to comply with Rule 101, a dentist needs to be contracted with one or more of the following:

  • DHS, (there are some counties where MHCP populations are not yet enrolled in a health plan or there may be eligibility issues that warrant the recipient to be on DHS for a period of time.)
  • Delta Dental of Minnesota, which administers the CivicSmiles Network 
  • HealthPartners
  • Itasca Medical Care (IMC)
  • Doral which administers dental benefits for UCare Minnesota
  • Altru or other contracted health plans

A 10 percent* threshold was set by the legislature, which allows a dentist to limit their practice to new MHCP patients if:

1.  The practice is closed to all new patients (all insurers even if it falls below the 10 percent) or
2.  The practice has reached a total of the practicing patient encounters as being MHCP patients.

*10 percent of all encounters (not patients)

Dentist Participation
All Minnesota dentists are eligible to join this network. Delta Dental would like to encourage dentists to participate in this network and continue to provide dental service for both existing patients and new patients. This contract allows the dentist or clinic to see all populations and serve health plan covered enrollees by this contract. Dental care for health plan enrollees is essential.

Dentists interested in participating in this network need to complete the following information:

  • Delta Dental of Minnesota CivicSmiles Dentist Participation Agreement - this agreement applies to the above information and all four public programs populations
  • If you agree to see Medicare members at the Premier reimbursement described below, sign the applicable Medicare information
  • Dentist or Clinic Credentialing information

Network Dentist Reimbursement
For MHCP members, metro-area participating dentists are reimbursed at a fee-for-service rate schedule, similar to the Minnesota Department of Human Services fee-for-service fee schedule. Non-metro participating dentists receive an added "rural access fee" which was implemented by the Department of Human Services, passed through by Delta Dental, to promote rural access to dental care. Dentists participating in this network who provide services to MHP and Medica MHCP members received an increase of 20 percent in reimbursement. As a result of the reimbursement change, dentists who provide services to MHP and Medica MHCP members are paid at the same rate as Community Clinics and Federally Qualified Health Centers (FQHCs).

For Medicare members enrolled in Medicare Advantage or Medicare Fee-For-Service programs, the reimbursement is at your Delta Dental Premier Maximum Allowable Charge. For dentists who do not participate in Delta Dental Premier, reimbursement is at the Delta Dental Premier non-participating table of allowance fee schedule as payment in full for covered services.

The Delta Dental reimbursement is considered payment in full for covered services provided to health plan members, and the balance may not be billed to the member.

To speak with a Network Services Representative about participation in this network, call 651-406-5900 ext. 4170 or
1-800-328-1188 ext. 4170.