Frequently Asked Questions - For The Dentists
Q: What are the benefits of participating with Delta Dental?
A: When you participate with Delta Dental, we will send payments directly to you based on your fees or Delta Dental's maximum allowance. As a participating dentist, 1) you have the convenience of submitting claims and checking claim status online, 2) you are eligible for electronic funds transfer and 3) you may even be eligible for daily claims payment. In addition, we will include your name in the participating dentist directory available to all groups and subscribers covered by Delta Dental of Kansas; plus your name will be listed in Delta Dental’s national directory of participating dentists.
Q: Can I choose to participate only with Delta Dental of Kansas?
A: By signing the contract to participate with Delta Dental of Kansas, you also agree to see patients who have coverage through other Delta Dental Member Companies.
Q: Can I participate with only one of Delta Dental’s groups?
A: When you sign an agreement for Delta Dental Premier® or Delta Dental PPOsm, you agree to see members of all groups who have purchased the program for their employees.
Q: If I don’t participate with Delta Dental, do my patients still have benefits?
A: Under most plans, your patient will still receive benefits, but he or she may have more out-of-pocket expenses and the Delta Dental payment will go directly to the patient.
Q: My patient has an exclusive Delta Dental PPO plan. How do I know if my patient is eligible for benefits?
A: If the group has selected an option that limits access based on the dentist's participation level, indication is made on the top right hand corner of the dental insurance card - "Must see a PPO provider for benefits." With these particular plans, if the patient chooses to see a provider outside his/her network, no benefits will be paid and full payment is the responsibility of the patient. For a patient's specific plan details, contact our Customer Service department at (800) 234-3375 or access Dental Office Services.
Q: How do I get a breakdown of my patient's dental coverage?
A: A dental benefits summary is available online. Please utilize Dental Office Services to view your patient's Benefits/Eligibility.
Q: My patient is covered under two dental plans. How is his/her coverage handled?
A: If your patient is covered by both Delta Dental of Kansas, another dental carrier or a medical plan that offers dental coverage, Delta Dental coordinates benefits with the other carrier. Generally, if the patient is covered as an employee and also as a dependent of an employee at another company, the coverage through the patient's employer is primary. Children covered by parents who work for different employers are usually primary under the plan of the parent whose birthday occurs first in a calendar year (not necessarily the oldest parent). Total payments from both carriers cannot exceed 100 percent of the approved fee for the service. Some groups have specified a "carve-out" clause in their dental programs that might limit a secondary carrier's payment. If you have questions about Coordination of Benefits, please contact our Customer Service department at (800) 234-3375.
Q: Why doesn’t Delta Dental of Kansas allow for posterior composite fillings?
A: Posterior composites are an optional benefit and must be selected by the employer in order to be included in the patient’s plan. Currently, more than 79% of our groups cover posterior composites.
Q: Which procedures require x-rays to be submitted with the Delta Dental of Kansas claim?
A: X-rays are required for veneers, anterior crowns, bridgework, crown buildups and implants. Copies of these x-rays need to be included when filing the claim. If you must send the original and need it returned to you, please clearly indicate your wishes on the x-ray and claim form.
Q: Am I required to submit a predetermination of benefits before beginning treatment on a patient?
A: In most cases, predeterminations are not required yet they are strongly encouraged. However, Delta Dental does have multiple groups that require predeterminations for payment on specific procedures. Predeterminations allow your patient the opportunity to make proper financial arrangements for their portion of the treatment cost before actual work begins. Predeterminations also reduce patients’ confusion about coverage levels and enhance goodwill among the dentist, the patient and Delta Dental.
Q: Do I have to submit a claim form every month for orthodontic work?
A: Submitting a monthly claim for orthodontics is not necessary. Normally, the claim is filed for the entire treatment, and Delta Dental automatically makes a payment each month until the treatment is completed, terminated, or the patient is no longer eligible.
Q: Do I have to take a write-off on a procedure that isn’t covered by the patient’s dental plan?
A: No, a participating Delta Dental provider is not required to take write-offs on procedures that are excluded by the patient's dental plan. If you have questions regarding this policy, please contact your Professional Relations representative. If you have questions about a specific patient's benefits and whether a specific procedure is covered, please call Delta Dental of Kansas' customer service department at (800) 234-3375.
Q: Can I bill the patient the difference between my fee and your allowance?
A: When you participate with Delta Dental, if your fee for a service exceeds Delta Dental's maximum plan allowance, participating dentists agree to write-off any difference and not charge the remaining balance to the patient.
Q: What date do I use on the claim form?
A: We recommend that you apply your normal billing procedures to all patients - "bill all on prep date or bill all on delivery.” (Excludes partials or dentures, which must be billed on seat date). While third-party claim submission policy offers dentists some latitude as to whether claims may be submitted at the commencement of procedures or at their conclusion, no ethical principle allows a dentist to bill and retain money for work that is not performed (ADA Ethics). Please note, however, that the policy for Delta Dental's national coverage groups continues to be that "benefits for multi-stage procedures are only available for completed services as determined by the date of insertion."
Q: How often does Delta Dental of Kansas increase maximum allowable charges?
A: Maximum allowable charges are reviewed on an annual basis.
If you have additional questions, please contact us.