2020 Plan Changes for Risk Groups

October 01, 2019

Each year Delta Dental of Kansas (DDKS) reviews potential policy and benefit changes for our members and groups. We would like to inform you of enhancements we will be offering on or after January 1, 2020 (at the group's renewal date). Please note which groups are affected for each enhancement below. If you have any questions, please reach out to your Professional Relations Representative.

Right Start 4 KidsSM (RS4K)

This plan design enhancement removes the cost barriers for dental care for children 12 and under. If the group chooses this enhancement, the program provides children 12 and under 100% coverage, with no deductible, for all services covered under the plan, excluding orthodontics, when a Participating Dentist is seen. If an out-of-network dentist is seen, the underlying contract applies including waiting periods, deductibles and coinsurance levels. Please verify the member's coverage and eligibility date.

Groups affected: Offered to all Risk groups; all Individual policies.

Implementation: On or after January 1, 2020. Please verify member's coverage and eligibility date. Coverage is based on current group or individual contract.

Unlimited Cleanings

If the group chooses this enhancement, members will be allowed unlimited cleanings. Covered codes include D1110, D1120 and D4910 (for D4910, previous surgical/non-surgical history is required). Please verify the member's coverage and eligibility date.

Groups affected: Offered to all Risk groups.

Implementation: On or after January 1, 2020. Please verify member's coverage and eligibility date. Coverage is based on current group contract.

Annual Maximum Increase to $1,500

If the group chooses this enhancement, annual maximums currently below $1,500 will be increased to an Annual Maximum of $1,500. Please note, groups with a buy-up option will not have an Annual Maximum increase on the base plan. Please verify the member's coverage and eligibility date.

Groups affected: Offered to all Risk groups. Groups with a buy-up plan option will not have an Annual Maximum increase on the base plan option.

Implementation: On or after January 1, 2020. Please verify member's coverage and eligibility date. Coverage is based on current group contract.

 

Have additional questions? Click here to contact your Professional Relations Representatives.

Processing Policy Changes Starting 1/1/2020

October 01, 2019
Mandatory Pre-Determination Removal:

Implementation: January 1, 2020

Groups affected: All Risk groups; all Individual policies.

Effective January 1, 2020 for Individual policies and all Risk groups, Pre-Determinations will no longer be mandatory for any code.

Scaling and Root Planing (Code D4341):

Implementation: January 1, 2020

Groups affected: All groups.

Effective January 1, 2020 for all groups, when scaling and root planing (SRP) is performed in 3 or more quadrants on the same day, the claim will be referred to dental consultants for review.

Review Criteria:

  • There must be 4 or more teeth in a quadrant.

  • Exposure of cemental surfaces of the root is necessary for root planing, therefore radiographs must show the crest of the alveolar bone more than 1.5 - 2.0 mm apical to the CEJ.

  • Submit periapical or bitewing radiographs and periodontal chart documenting probing depths, amount of attached gingiva and clinical attachment levels.

Please Note: Panoramic radiograph (D0330) will no longer be accepted for SRP claims documentation and determination. According to the American Academy of Periodontology, panoramic X-rays have limited value in the diagnosis of periodontal disease (Delta Dental Dentist Handbook, Pg. 67).

General Anesthesia and IV Sedation (Codes D9222, D9223, D9239, & D9243):

Implementation: January 1, 2020

Groups affected: All groups.

Effective January 1, 2020 for all groups, if general anesthesia and IV sedation are performed in excess of one hour, the claim will be referred to dental consultants for review.

Review Criteria:

  • Submit anesthesia record showing start/stop times, vitals checked, anesthesia used, etc.

  • Submit chart notes which should include procedure(s) performed and, if necessary, the reason/necessity for additional anesthesia.

Fabrication of Athletic Mouthguard (D9941):

Implementation: January 1, 2020

Groups affected: All Risk groups; all Individual policies

Effective January 1, 2020 for Risk groups and Individual policies, D9941 will be a covered Major service under the group's plan, excluding plans that do not have coverage for Major services. The underlying contract, age limitations and frequency limitations apply.

 

Have additional questions? Click here to contact your Professional Relations Representative.

Delta Dental of Kansas Board of Directors Updates

October 01, 2019
Delta Dental of Kansas Board of Directors has new Chair and Vice Chair

Gary Yager has been named Chair of the Delta Dental of Kansas board of directors.

Dr. Brick Scheer has been named Vice Chair of the Delta Dental of Kansas board of directors.

Dr. Patrick Moriarty to continue to serve on Delta Dental of Kansas Board of Directors

During the 2019 Annual Meeting held on August 10th, Dr. Patrick Moriarty was reelected to the DDKS Board of Directors for another four year term.

Community Benefit Dental Plan through United Way of the Plains

October 01, 2019
What is the Delta Dental Community Benefit Plan?

Delta Dental of Kansas has partnered with United Way to fund dental coverage for those who would otherwise not be able to afford it. Through this partnership, United Way determines if an individual/family is eligible for the dental plan. Once an individual/family is in the plan, they receive coverage at 100% for all services with a $5 deductible, up to a $3,000 annual maximum.

The Delta Dental Community Benefit plan began just in the Wichita, KS area as a pilot program. In summer 2019, the program has expanded state wide.

How do you refer a patient?

You may refer patients to the program by giving them information on how to contact United Way to apply for the dental plan. The individual will need to call 2-1-1 and ask about the Delta Dental Community Benefit Dental Plan. From there, the United Way of the Plains will provide additional details on the plan, determine if they are eligible, and if so, get them set up on the plan.

We will have small handouts available upon request that you can have on hand. These handouts will have information on what that individual would need to do to sign up for the plan. To request these handouts, please contact us here.

DDKS Quarterly Reminders - October 2019

October 01, 2019

The Delta Dental of Kansas offices will be closed

November 28 & 29 - Thanksgiving

December 24 after 12 p.m.; December 25 & 26 - Christmas

December 31 after 12 p.m.; January 1 - New Years

 

Upcoming Events

Understanding Dental Insurance Seminar Opportunities:

11/15/2019 - Wichita, KS (9 a.m. - 12 p.m.)

11/15/2019 - Leawood, KS (9 a.m. - 12 p.m.)

Registration and more information available here.

 

Dental Office Changes or Updates? Please notify us when:

  • New and/or change of physical or payment address(es)
  • New and/or change of phone number(s)
  • A dentist joining or leaving
  • Closing of an office
  • Tax information changes
  • New and/or changed NPI information
  • Retirement
  • Sale or purchase of practice
  • License status updates

Annual DDKS Membership Meeting

July 02, 2019

All Delta Dental of Kansas (DDKS) Member Dentists are invited to attend the DDKS Annual Membership Meeting on Saturday, August 10, 2019, at 8:30 a.m. at the DDKS Corporate Headquarters, 1619 N. Waterfront Parkway, Wichita, KS 67206. Registration is not required.

During the meeting, a participating dentist will be elected to the DDKS Board of Directors. A Nominating Committee was appointed by the DDKS Board Chair, as required by the DDKS Bylaws. The Committee met on June 20 and nominated Dr. Patrick Moriarty to succeed himself for another four-year term on the DDKS Board of Directors. Additional nominations for the vacancy may be made by written petition containing the name nominated, signed by at least ten (10) members in good standing, and delivered to the DDKS Chairperson of the Board at least five (5) days prior to the Annual Meeting at the address below:

Dr. Alan Marcotte, Board Chair
Delta Dental of Kansas, Inc.
P.O. Box 789769
Wichita, KS 67278-9769

Tips to Submit Multi-Option & Multi-Phase Pre-Treatment Estimates

July 02, 2019

A Treatment Plan With Multiple Treatment Options:

When submitting pre-determinations (or pre-treatment estimates) with multiple treatment options for your patient, submit each different treatment option on a separate claim form so that each pre-determination is processed independently. Add comments in the remarks section on the claim form noting treatment option #1, treatment option #2, etc. When you receive your pre-determinations back from us, you should see reference code 937 - optional treatment plans were submitted. Only one of the treatment plans will be allowed.

A Treatment Plan With Multiple Sequential Phases:

In order for a treatment plan with multiple phases to process chronologically, submit the different phases of the treatment plan on separate claim forms indicating the phase number in the remarks section (i.e. Phase 1 of 3, Phase 2 of 3, etc.). If you try to submit a multi-phase treatment all on one claim form, the procedures will automatically re-organize in numerical order by ADA codes instead of the intended treatment order.

Following these helpful tips should lead to a more efficient and accurate predetermination experience for your office.

Have additional questions? Contact your Professional Relations Representative.

Dental Claim Submission Tips

July 01, 2019

Updated ADA Claim Form Available Here:

The ADA recently updated their dental claim form. You can find a copy of the updated form on the Forms page by selecting the button below, or by logging in to your dentist account and visiting the Documents and Dentist Handbook section.

Access Forms

Tax Identification Number (TIN)

Submit all claims using the billing dentist/dental entity TIN.

If there is a change to the TIN or the name associated, please notify us so we can complete the TIN change on our end as well. It's important to submit the correct TIN based on the date of service. Any claims with a date of service prior to the TIN change should be submitted using the old TIN, and any claims submitted with a date of service after the TIN change should be submitted using the new TIN.

National Provider Identifier (NPI)

The ADA dental claim form provides space for both the NPI Type 2 (business) and the NPI Type 1 (individual). If your office is registered for a Type 2 NPI, please input it in box 49 of the claim form. If no Type 2 NPI is available, leave box 49 blank. Always include the treating dentist's Type 1 NPI in box 54. Making sure your NPI is in the correct place on the claim form can prevent claims processing delays and denials. For more information, or to manage/apply for your individual or organizational NPI, visit nppes.cms.hhs.gov.

Treating Dentist and Location

The name, NPI Type 1 and License Number of the treating dentist must be included in the Treating Dentist and Treatment Location section of the ADA claim form.

The only exception to this is when a substitute dentist is filling in for a dentist who is absent from his/her practice due to illness, injury, birth of a child, etc. (locum tenens).

The owner's name should never be substituted for the name of the dentist who actually performed treatment on the patient. The treatment location should not reflect the home office or billing office unless it reflects the actual place of treatment.

D0145 Processing

July 01, 2019

D0145 - Oral evaluation for a patient under three years of age and counseling with primary caregiver

Descriptor: Diagnostic services performed for a child under the age of three, preferably within the first six months of the eruption of the first primary tooth, including recording the oral and physical health history, evaluation of caries susceptibility, development of an appropriate preventive oral health regimen and communication with and counseling of the child's parent, legal guardian and/or primary caregiver.

 

D0145 is not identified as either comprehensive or periodic and can be used as an initial visit with the child as well as on subsequent visits that include an oral evaluation. This code is appropriate as long as the child remains under the age of three and includes preventive counseling provided to the primary caregiver. Otherwise, D0120 is used when no counseling is provided to the primary caregiver during the visit.

If D0150 comprehensive oral evaluation new or established patient is submitted on a claim for a patient under the age of three, you will receive a response on the remittance advice stating “Patient is over/under the age limitation allowed for this procedure”. A new claim is required that lists the correct ADA procedure code.

Please note, we are currently working on updating our system process so that in the future, we will automatically benefit D0145 when a claim includes D0150 for a child under the age of three.

DDKS Quarterly Reminders - June 2019

June 30, 2019

The Delta Dental of Kansas offices will be closed

July 4 - Independence Day

September 2 - Labor Day

 

Upcoming Events

Delta Dental of Kansas Annual Meeting for Participating Dentists:

8/10/2019 - Wichita, KS (8:30 a.m.)

Understanding Dental Insurance Seminar Opportunities:

9/6/2019 - Wichita, KS (9 a.m. - 12 p.m.)

9/6/2019 - Leawood, KS (9 a.m. - 12 p.m.)

Registration and more information available here.

Contact Us

For more information on becoming a Delta Dental participating dentist, contact Delta Dental of Kansas’ Professional Relations team at 800-733-5823, email PR@deltadentalks.com, or fill out the form below.

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