Provider Network Descriptions
The information this page is intended for Delta Dental Providers. If you are a member or employer, please visit Delta Dental Networks.
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, Delta Dental PPO Plus Premier™ - Dental Flex and national dental benefit plans. In Minnesota, Delta Dental Premier® has more than 2,860 participating dentists. Advantages of becoming a Delta Dental Premier® dentist include:
- Access to the 4.1 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
Delta Dental Premier® 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
Delta Dental Premier® 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.
The Delta Dental Premier® National Network
Delta Dental offers programs to national account groups. Dentists participating in the local Delta Dental Premier® network through other states make up a nationwide network of providers. Delta Dental Premier® is the largest dental network in the country with more than 154,000 participating dentists. See if your office listing is current.
Delta Dental PPO™ Network
In Minnesota, Delta Dental PPO™ has approximately 1,870 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.
Delta Dental PPO™ 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.
Delta Dental PPO™ Network 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.
The Delta Dental PPO™ National Network
Delta Dental offers programs to national account groups. Dentists participating in the local Delta Dental PPO™ network through other states make up a nationwide network of providers. Our national PPO™ network has more than 108,000 participating dentists practicing in 261,000 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).
State of Minnesota (State Dental Plan/Group 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 (State of Minnesota (State Dental Plan/Group 216)
Minnesota's Rule 101 requires dentists in the seven-county metropolitan area 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.
State of Minnesota (State Dental Plan/Group 216) 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.
This network was created to support the programs administered by Delta Dental of Minnesota for Minnesota Health Care Program enrollees. These include: MinnesotaCare, Medicaid, Prepaid Medical Assistance Program (PMAP), Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus (MSC+), and Special Needs BasicCare (SNBC). Currently, Delta Dental of Minnesota administers dental services for Blue Plus, Hennepin Health, Medica, UCare and South Country Health Alliance.
This network currently supports the UCare for Seniors and UCare EssentiaCare Medicare Advantage products. Providers must participate in the CivicSmiles network in order to join the CivicSmiles Senior network. Members can see both participating and non-participating providers. Providers who have opted out of Medicare are not able to participate in this network.
Minnesota’s Rule 101 (CivicSmilesSM and CivicSmilesSM Senior)
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 a dentist who practices in the seven-county metropolitan area 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
- Itasca Medical Care (IMC)
- South Country Health Alliance
A 10 percent* threshold was set by the legislature, which allows a dentist to limit their practice to new MHCP patients if:
The practice is closed to all new patients (all insurers even if it falls below the 10 percent) or The practice has reached a total of the practicing patient encounters as being MHCP patients. *10 percent of all encounters (not patients)
CivicSmilesSM Senior 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 Dentist or Clinic Credentialing information
CivicSilesSM and CivicSmilesSM Senior Network Dentist Reimbursement
CivicSmilesSM Reimbursement: Reimbursement is set by the Minnesota Department of Human Services base fee amounts, and each individual health plan determines any additional increases. The Critical Access Dental (CAD) program adds an additional percentage to qualifying clinics that is reimbursed at the point of service. All payments are made directly to the provider.
CivicSmilesSM Senior Reimbursement:
The CivicSmiles Senior Network pays at a PPO-like rate. If a member chooses to see a non-participating provider, the member is responsible for charges billed over the contracted rate, and the check is sent to the member. Providers who have opted out of Medicare are not able to participate in this network.