Delta Dental of Kansas' quarterly newsletter highlighting current topics for Participating Dentists and Staff
2018 Participating Dentist Handbook & PPO FEE Schedule
Participating Dentist Handbook
The Delta Dental of Kansas (DDKS) Participating Dentist Handbook (also known as the Processing Policies and Procedures Reference Guide) is a helpful reference tool for both dentists and staff. This guide contains current Codes on Dental Procedures and Nomenclature (CDT Code) along with the corresponding national Delta Dental processing policies.
In the first several pages of the handbook, you will find the "What You Need To Know" section. This section contains information covering membership, credentialing, submitting claims/predeterminations, appeals, electronic services and more.
It is important that participating dentists familiarize themselves with the handbook. The updated 2018 handbook will be available by December 31, 2017 within the Dental Office Services portal accessed at DeltaDentalKS.com. You will find the handbook within the "Documents & Dentist Handbook" section within the portal.
If you need assistance creating a Dental Office Services portal login and password, or need help navigating our website, please contact DDKS Customer Service at 800.234.3375 or your local Professional Relations Representative.
Key Points from the 2018 handbook:
The handbook includes requirements set forth under the Administrative Simplification Provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and related regulations. It is the policy of Delta Dental to comply with all requirements, as well as to require all Participating Dentists to comply. To be consistent with HIPAA, Delta Dental exercises its right to determine claims reimbursement procedures and requires the processing of such codes in accordance with National Delta Dental policies unless prohibited under other applicable law or specific group contract provisions. Such policies include charging correct amounts for procedures without inflation or manipulation.
Regardless of the network, Participating Dentists cannot balance bill beyond the maximum plan allowance (based on each product) except for contractual non-covered services. Participating Dentists must accept their approved maximum plan allowance for all contractually covered services even when the fee is not payable because of a deductible, for benefits with frequency limitations or waiting periods, or for services performed after the patient reaches his or her annual maximum benefit.
Delta Dental dentists are automatically part of the national Delta Dental Premier program once contracts are signed and approved. A separate PPO contract is required for inclusion in the PPO network. As a participant in one or both of these national programs, you accept the payment and claims processing policies set forth by Delta Dental.
Delta Dental PPOSM Fee Schedule
The 2018 Delta Dental PPO Fee Schedule will be available by December 9, 2017 within the Dental Office Services portal access at DeltaDentalKS.com. You will find the fee schedule within the "Documents & Dentist Handbook" section within the portal.
Please Note: Delta Dental's PPO program is an optional program for participating dentists with a separate contract. Contact your local Professional Relations Representative if you would like to participate in or learn more about the PPO network - or send an email requesting more information to email@example.com.
2018 Procedure Code & Processing Policy Changes
CDT 2018 Procedure Code Changes
The American Dental Association (ADA) has published the new procedure 2018 codes. To order CDT 2018 items, visit adacatalog.org or contact the ADA at 800.947.4746. Changes for 2018 include: 18 new codes, 3 deleted codes and 18 revised codes.
CDT is the national standard for reporting dental services and serves as the HIPAA standard code set. Any claim submitted electronically or by paper must use procedure codes from the current version of the CDT manual.
Please note, the listing of a procedure code does not mean that the procedure code is a covered or reimbursable benefit within a dental benefits plan.
For a full list of CDT 2018 procedure code changes, log in to the Dental Office Services portal accessed at DeltaDentalKS.com. You will find the "CDT 2018 Procedure Code Changes" document within the "Documents & Dentist Handbook" section within the "Dentist Briefcase".
A few notable updates:
Processing Policy Changes(effective 1-1-18 unless noted otherwise)
Bitewing images for patients under age 10 - A D0273 or D0274 submitted for a patient under age 10 may be processed as D0272 and the excess fees of D0272 may be disallowed. Rationale: The size of a child’s dental arches under age 10 does not typically allow for four bitewings.
D0230 intraoral - periapical - each additional radiographic image – DDKS will follow the DDPA longstanding policy which states “Routine working and final treatment radiographic images taken by the same dentist/dental office for endodontic therapy are considered a component of the complete treatment procedure. Separate fees for these images are DISALLOWED. Beginning in 2018 only one radiographic image taken on the same day as endodontic therapy will be benefitted".
D0274 bitewings – four radiographic images and D0330 panoramic radiographic image – these radiographic images, when taken on the same service date, will no longer be benefitted separately beginning March 1, 2018. DDKS will begin following the national policy, which states “a panoramic radiographic image, with or without supplemental radiographic images (such as periapicals, bitewings, and/or occlusal radiographic images) is considered a complete series for time limitation purposes and any fee charged in excess of the allowance for a complete series (D0210) is DISALLOWED".
D2952 and D2954 – When radiographs indicate more than half of the coronal tooth structure remains, fee for post and cores are DENIED. The following reference will apply “Documentation submitted does not allow benefits for this procedure. Fee is the patient’s responsibility, up to Delta Dental’s Maximum Allowance”.
D4341 and D4342 Periodontal scaling and root planing – four or more/one to three contiguous teeth or teeth bounded spaces per quadrant – The focus is placed on bone and attachment loss and less on pocket depth although pocket readings of at least 4 mm are typically present – “there must be radiographic documentation of bone loss or loss of clinical attachment on the diseased teeth/periodontium involved. In the absence of bone loss or loss of clinical attachment a benefit for scaling and root planing cannot be made". Your claim will be denied asking that you submit a new claim using the correct procedure code that best represents the treatment rendered.
D4355 Full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit – DDKS will no longer benefit D0150, D0160 or D0180 on the same service date as D4355 due to the clarification made in The Code by the ADA. The new wording is:
National EFT/ERA Current Project Status
If you need assistance locating ERAs, please review the July BrushUp, or contact your Professional Relations Representative.
Dental Office Services Portal Announcement:
Improved Design Changes Coming
Delta Dental Plans Association (DDPA), the Delta Dental national association, will soon launch an enhanced website. The main goal of this update is to provide a better user experience and reduce the number of clicks to reach the desired content. The only time you will see the updated site is when you click a link within the DDKS Dental Office Services portal or DDKS website that directs you to the DDPA website.
For example, within the Dental Office Services Portal, after seleccting the Check National Electronic Remittance Advice (ERA) option in the Payments tab, users are redirected to the DDPA website. Once the update is deployed, you will see a screen much like this:
To access DentalXChange (DxC) to retrieve ERAs, simply click Delta Dental ERAs or select Explanation of Payment Links to access ERAs from Member Companies not yet utilizing DxC, which are both located in the Check national ERA section at the upper right corner of the new web page.
Keeping you informed: Employer Group Plan Design Changes Effective 1-1-18
Some of our groups have made modifications to their group plans beginning 1-1-18. Here is a list of some of those plan changes (this list is also available in the "Dentist Briefcase" within the Dental Office Services portal):
*Preventive Plus: Diagnostic & Preventive do not accumulate to annual max.
**Rollover Maximum: Enrollees carryover 25% of their unused annual maximum to the following year.
***Incentive: Must meet Diagnostic & Preventive criteria to earn higher percentage of restorative and/or major coverage.
We try to update you as much as we can, but we always recommend that you verify patient coverage and benefits each time your patient seeks treatment at your office. You can easily do this by logging into the Dental Office Services portal.
When verifying benefits near the end of a groups plan benefit year, please keep in mind that benefits may reset on a date prior to the actual benefit year change. If you are planning treatment, you can check online for most coverage details, but if it appears your patient's benefits have reset in preparation for the upcoming benefit period, please call Customer Service at 800.234.3375.
Delta Dental Individual & FamilySM Plans
New 2018 Rates
You should have received new 2018 brochures for Delta Dental of Kansas' Individual & Family plans by mail. These updated brochures have the correct rates for 2018.
Please use these brochures, and discontinue using the old brochure. Any enrollee who enrolls AFTER November 25, 2017 will have a 1-1-18 start date, and will have the 2018 rates.
New 2018 Brochures:
Please send requests for additional brochures to firstname.lastname@example.org.
For information on Delta Dental's Individual & Family plans, visit DeltaDentalKS.com/IndividualOptions.
Matching Gift Program for Participating Dentists
Through Delta Dental of Kansas' (DDKS) Matching Gift Program, Participating Dentists are able to make donations to an approved list of eligible organizations and have DDKS match that gift. Approved charitable donations may be matched up to $100.
2017 Matching Gift Applications must be submitted by December 15, 2017 to Delta Dental of Kansas' Community Benefit department at email@example.com.
To view a list of approved organizations, access the 2017 application and learn more about the matching gift program, visit DeltaDentalKS.com/CommunityBenefit/MatchingGiftProgram.
Important Dates & Upcoming Events
Dental Office Changes or Updates: Please Notify Us
Please contact the Professional Relations department by phone at 800.733.5823, by fax at 316.462.3317 or by email at PR@deltadentalks.com for any dentist and/or office changes or updates.
When to notify us:
To insure proper claims payment, please notify the Professional Relations department of all changes/updates in advance and note the effective date.
Meet Your PR Representative
Who is your Professional Relations Representative? Click here to meet your representative.
Click here to access Delta Dental of Kansas' Kids Wellness Program:
an oral wellness resource for your patients.
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