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:
- You agree to file claims for your Delta Dental patients and report your usual fees on a confidential basis.
- You agree to accept direct payment from Delta Dental.
- You agree that subscribers will not be charged more than the pre-established coinsurance amount. In other words, you agree not to balance bill patients any difference between the Delta Dental approved amount and your usual fee, if any.
- You agree to fee verifications and periodic record reviews.
- You agree to submit diagnostic aids (such as X-ray films) as necessary to help Delta Dental verify that treatment is covered by the group contract.
- You agree to cooperate with state or local peer review committees and with dental consultants.
- You agree to update Delta Dental’s Professional Services area with your most current dental practice information (i.e. credentialing information) at least once every four years.
3. How does Delta Dental determine the dentist’s reimbursement level?
The usual fees of each participating dentist are filed confidentially with Delta Dental of Minnesota. Delta Dental pays participating dentists the appropriate percentage of the usual fees, or the fees actually charged, whichever is less, subject to fee table maximums. Payment of the dental plan’s obligation is made directly to the participating dentist. Delta Dental of Minnesota participating dentists accept this reimbursement as payment in full for services covered under the plan. This fee table is not published; however, a Delta Dental Network Representative can assist dentists in determining the allowable fee for their top 20 procedures.
4. Does Delta Dental require credentialing?
Delta Dental believes in nurturing long-term partnerships with highly qualified individuals and organizations who share our commitment to quality dental care and services. As part of our commitment to quality, Delta Dental of Minnesota has a formalized credentialing process through which we objectively evaluate dentists against formalized standards.
6. How should I submit procedures that are being done for cosmetic purposes?
Procedures that are not covered, such as cosmetic procedures, should not be submitted to Delta Dental. If a patient requests or requires a denied Estimate of Benefits for a secondary carrier or a flex plan, please send the pre-estimate directly to our Professional Review Department with a note stating that the procedure is not covered or is being done for cosmetic purposes and the patient needs a denial.
Delta Dental of Minnesota
Attn: Professional Review Department
PO Box 9304
Minneapolis, MN 55440-9304
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?
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.
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.
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.
The following questions relate to 835/Electronic Remittance Advice.
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.