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Frequently Asked Questions

Find answers to your questions below.

Accessing Patient Information

My patient is covered under two dental plans. How is his/her coverage handled?

If your patient is covered by both Delta Dental of Kansas and 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% 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 team.

How do I get a rundown of my patient’s dental coverage?

You can easily and quickly view your patient’s benefits/eligibility through your online account. Log in to your account by clicking here. Once logged in, select the Kansas Provider Toolkit, and then select Patient Benefits or Benefit Rundown.

You can also use Benefits Faxback to verify benefits and eligibility via fax by dialing 1-877-FAX-DDKS. You will get an automated voice response that will lead you through simple instructions. Once you’re done inputting all of your patient’s identification numbers, a fax will be sent to you immediately.

My patient has an exclusive Delta Dental PPO plan. How do I know if my patient is eligible for benefits?

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, visit your online account or contact our Customer Service team.

Claims

What date do I use on the claim form?

We recommend that you apply your normal billing procedures to all patients. The National Processing policy requires that multi-stage procedures are reported and benefited upon completion. The definition of completion dates include: date root canal is completed (i.e. sealing the pulp chamber and canal to the apex of the root), the date the final prosthesis is seated in the patient’s mouth, the date of insertion for removable prosthetic appliances, the date the remaining teeth are removed and the denture is inserted for immediate dentures and final cementation date for fixed partial dentures, crowns, onlays and inlays regardless of the type of cement.

Do I have to submit a claim form every month for orthodontic work?

Submitting a monthly claim for orthodontics is not necessary with Delta Dental of Kansas (DDKS). Generally, the claim is filed for the total amount for the entire treatment, starting with the banding date. DDKS Automatically makes a payment each month until the treatment is completed, terminated, or the patient is no longer eligible.

Am I required to submit a predetermination of benefits before beginning treatment on a patient?

In most cases, predeterminations are not required, but they are strongly encouraged. 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 dentists, the patient and Delta Dental.

Please keep in mind that the predetermination we provide is not a guarantee that benefits will still be available on the date treatment is provided. If the patient's benefits change before the treatment is completed (or starts), the estimate won't be accurate. The following actions will also render a predetermination of benefits inaccurate:

  • Loss of coverage
  • Changes in your network participation with us
  • Benefits provided by other medical or dental plans
  • Changes to dental codes or treatment made
  • Changes in appointment location

Which procedures require X-rays to be submitted with the Delta Dental of Kansas claim?

X-rays are required for certain procedures including, but not limited to, veneers, anterior crowns, bridgework, crown buildups and implants. Please include copies of diagnostic X-rays 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.

Why doesn’t Delta Dental of Kansas allow for posterior composite fillings?

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 88% of our groups cover posterior composites.

My patient is covered under two dental plans. How is his/her coverage handled?

If your patient is covered by both Delta Dental of Kansas and 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% 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 team.

Participating in the Delta Dental Network

Does Delta Dental of Kansas offer any continuing education classes/seminars?

Yes, Delta Dental of Kansas regularly schedules seminars, webinars and workshops to assist dental professionals and their office personnel with claim submissions and any questions on Delta Dental’s general policies. Click here for a list of our upcoming seminars.

How often does Delta Dental of Kansas update maximum allowable charges and how do I find a copy of a fee schedule?

Maximum allowable charges are reviewed on an annual basis. Delta Dental notifies providers via email when updated PPO fee schedules are made available in your online dentist account in the Documents & Dentist Handbook section. Additional practice specific details about both Premier and PPO networks are available online in your dentist account by accessing Reporting in the Kansas Provider Toolkit.

To update or verify we have your correct dental office email, please contact our Professional Relations team.

Can I bill the patient the difference between my fee and your allowance?

When you participate with Delta Dental, if your fee or 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.

Do I have to take a write-off on a procedure that isn’t covered by the patient’s dental plan?

No, participating Delta Dental provider is not required to take write-offs on procedures that are excluded as a non-covered service 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 contact our Customer Service team.

If I don’t participate with Delta Dental, do my patients with Delta Dental insurance still have benefits?

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.

If your patient has a PPO-only plan (or an Exclusive Provider Option Plan), that means that patient would only receive benefits if they visit a Delta Dental PPO dentist. Visiting a Premier only provider is considered out-of-network for PPO-only plan designs and the patient would owe the full dental office fee with no write-offs.

Can I participate with only one of Delta Dental’s groups?

Providers have the choice to participate in the Premier only network or participate in both the PPO + Premier networks. 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.

Can I choose to participate only with Delta Dental of Kansas?

By signing the contract to participate with Delta Dental of Kansas, you also agree to participate with Delta Dental companies nationwide and see patients who have their coverage.

What are the benefits of participating with Delta Dental?

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 (EFT/ERA) and 3) you may be eligible for daily claims payment. When you participate with Delta Dental, we will send payments directly to you based on your fees or Delta Dental’s maximum allowance. In addition, we will include your name in the participating dentist directory available to all groups and members covered by Delta Dental of Kansas, plus your name will be listed in Delta Dental’s national directory of Participating Dentists.

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