2018 End of Year Updates

December 21, 2018

Delta Dental Participating Dentist Handbook

The dentist handbook is an extension of the Participating Dentist Agreement and is designed to provide important information related to the general processing policies and guidelines for all ADA CDT procedure codes, along with other helpful information such as definitions, submitting claims, appeals and using electronic services.

The 2019 handbook will be available online by December 31, 2018. To access, log in to your dentist account and click on the "Documents & Dentist Handbook" section.

If you need assistance creating or navigating your dentist account, contact our Customer Service team or your Professional Relations Representative.

Delta Dental PPO Fee Schedule

The 2019 Delta Dental PPO Fee Schedules were mailed on November 14 to all general dental offices participating in the Delta Dental PPO network. The PPO Fee schedule is also available online, in the "Documents & Dentist Handbook" section of your dentist account.

Contact your local Professional Relations Representative if you would like to participate in or learn more about the PPO network - or request more information here.

Detailed Dentist Snapshot (DDS Report)

We've made it easy for you to access the reporting you want. Check out the "Dentist Snapshot Report" in the "Reporting" section in your online dentist account. In this report you'll find:

  • all procedure codes submitted within the selected reporting period
  • your most commonly submitted fee for each procedure and the allowed Premier and PPO amounts
  • your percentage of Premier and PPO patients (regardless of your participation status)
  • your number of claims submitted and the percent that were submitted electronically
  • direct deposit enrollment details
  • your top denied codes and explanation
  • the number of calls made by your office to us and the purpose of the calls
  • patient trends in your practice
  • the top Premier and PPO groups that make up your patient base

2019 CDT Procedure Code Changes

December 19, 2018

The American Dental Association has published the new procedure codes for 2019. Changes include: 15 new codes, 4 deleted codes and 7 revised codes.

To order CDT 2019 items, visit adacatalog.org or contact the ADA at 800.947.4746.

Please note: the listing of procedure codes does not mean that the procedure code is a covered or reimbursable benefit within a dental benefits plan.

Processing Policy Changes Effective 1-1-19

December 18, 2018

D8660 Pre-orthodontic treatment examination to monitor growth and development – This procedure code is not a benefit for patients with orthodontic history. A “pre” orthodontic visit must be performed on a date preceding orthodontic banding or delivery of aligners. Fees for D8660 submitted on the same date of service as D8070, D8080 or D8090 are not billable to the patient.

Explanation: A “pre” orthodontic visit must be performed on a date preceding orthodontic banding or delivery of aligners.

Evaluations – age limitation changes – D0145 oral evaluation for a patient under three years of age and counseling with primary caregiver.

The following codes are for patients ages 3 years and older:

  • D0150 (comprehensive oral evaluation – new or established patient)
  • D0160 (detailed and extensive oral evaluation – problem focused, by report)
  • D0180 (comprehensive periodontal evaluation – new or established patient)

Claims will be processed based upon the appropriate evaluation code according to age. D0120 (periodic oral evaluation – established patient) remain valid for ages 0-99.

Employer Group Plan Design Changes Effective 1-1-19

December 17, 2018
  • Amarr Entrematic (Group #1498) - Diagnostic and Preventive changing to two (2) times per calendar year. Periodontal surgical re-entry frequency limit changing from 24 months to 36 months. Adding Preventive Plus*.
  • Axcet HR Solutions (Group #50064) - Adding posterior composite coverage.
  • Georgia Pacific (GP) (Group #53000, #53001, #53002) - Adding Preventive Plus* to group #'s 53000-0-1-0, 53000-0-2-0, 53000-0-3-0, 53000-0-4-0, 53001-0-1-0, 53001-0-2-0, 53001-0-36-0, 53001-0-37-0. Adding adult orthodontics to Flex Ortho only (53000-0-3-0, 53000-0-4-0). Changing orthodontic age to 26 on ALL GP groups that include orthodontic coverage.
  • Koch Industries (Group #50950) - Adding Preventive Plus* (excludes group #50951).
  • Stormont Vail Healthcare (Group #91504) - Adding adult and child orthodontics with $1,000 separate orthodontic maximum. Adding deductible of $50/person up to $150/family (was previously no deductible).
  • YRC (Group #90305, #90405, #90505, #90705, #92305, #92405, #92505, #92605) - Adding Incentive Plan (Benefits will increase from the base level to the incentive level if the member receives a routine exam and/or cleaning at least one (1) time in twelve (12) months. Benefits will increase to the incentive level ninety (90) days after a cleaning and/or exam. Benefits for new members will begin at the incentive level. After twelve (12) months, benefit levels will be determined by the date of the last Diagnostic or Preventive treatment).

*Preventive Plus - Diagnostic & Preventive services do not accumulate to Annual Maximum.

Please be aware plan changes may occur at the beginning of a plan year. Plan rollovers occur throughout the month of December for the new year, to verify current year accruals contact Customer Service at 800.234.3375.

As a best practice, we recommend that you verify patient coverage and benefits each time your patient seeks treatment at your office. You can easily check by logging in to your dentist account.

**New group Announcement** - Pfizer employees will be covered under the Delta Dental PPO plan through Delta Dental of New York effective January 1, 2019. Delta Dental of New York’s contact center is happy to answer any questions about this transition. Please feel free to call 888-893-4411.

Delta Dental Individual & Family Platinum Plan Rates are Changing in 2019

December 11, 2018

2019 brochures for Delta Dental of Kansas' Individual & Family plans have been mailed out. These updated brochures have the correct rates for 2019.

Please use the 2019 brochures and discard the old brochures. Any enrollee who enrolls AFTER November 25, 2018 will have a 1-1-19 start date, and will have the 2019 rates.

Please fill out this form to send additional requests for brochures.

Learn more about our Individual and Family Plans.

Using the Delta Dental Logo to Promote Your Practice

December 03, 2018

You're welcome to use the Delta Dental logo to promote your practice - here's how:

  • Contact your Professional Relations Representative and ask for them to send you the Delta Dental logo.
  • Use the Delta Dental logo on your website or other materials to promote that you are a Delta Dental dentist. (Follow the size and spacing guidelines when using the logo.)
  • Send your Professional Relations Representative a link or an example of how you're using the logo for approval.

You can view the logo size and spacing guidelines flyer by accessing your dentist toolkit in your online dentist account.

Using Your Online Dentist Account: Updates & Answers

October 25, 2018

UPDATES

Benefits by procedure code -

When looking up patient benefits by procedure code, you will now be able to see the patient's coinsurance benefit percentage for all three network participation levels - PPO, Premier (Par), and non-participating (NonPar). Our goal is to provide transparency in benefit levels.

Benefit Rundown -

Your patient's coinsurance benefit percentages for all three network participation levels have also been added to the Benefit Rundown portion of the Provider Toolkit.

In addition we've added a new link so you can easily access the same patient's Group Benefits, Dates of Service and Accumulators from the Benefit Rundown page without reentering the patient's member ID number. Simply click the "Group Benefits, Dates of Service and Accumulators" link.

ANSWERS

What does "Paid as PPO?" mean?

When looking at your Patient's Group Benefits, Dates of Service and Accumulators in the Provider Toolkit, "Patient Benefits", you'll notice a line that says "Paid as PPO?". This will tell you if the payment is made using the Delta Dental PPO fee schedule or the Premier Maximum Plan Allowance (MPA).

Yes = PPO Fee Schedule

No = Premier MPA

Are you registered for an online dentist account?

It's an easy and quick way to look up your Delta Dental patient benefits, access forms and other important information.

Register for your dentist account here.

Least Expensive Professionally Acceptable Treatment (LEPAT)

October 12, 2018

Most dental plans include verbiage limiting payment to the least expensive professionally acceptable treatment, also referred to as LEPAT or LEAT.

Example: A patient has missing teeth on both sides of the same arch. The treatment plan may be a fixed bridge or implants, but because the teeth are missing bilaterally, the benefit is limited by the dental plan contract to a metal frame partial denture (the LEPAT). The patient would be responsible for any difference in cost from the allowance for the LEPAT and the chosen treatment.

The dental plan does not dictate treatment. You and your patient should choose the treatment that best fits your patient's needs and budget. Predetermination of benefits are recommended to avoid any confusion or financial surprises.

Dental Benefits for Military Retirees: Transitioning from the Tricare Retiree Dental Program to the Federal Employees Dental and Vision Insurance Program (FEDVIP)

October 08, 2018

What is Tricare?

The Tricare Retiree Dental Program is a dental program for military retirees that will be ending at the end of this year. It has been administered by Delta Dental in California for 20 years. Some of your patients may be in this dental program.

What is changing for my Tricare Patients?

In order for Military retirees to have access to vision insurance as well as dental insurance, the Tricare Retiree Dental Program is ending, and instead military retirees will be able to enroll with the Federal Employees Dental and Vision Insurance Program (FEDVIP). Through this program, military retirees can still sign up with Delta Dental (administered by Delta Dental in California), but can also choose from 5 other dental plan options, and 4 vision plan options.

If a patient enrolled in Tricare has questions, how can I help them?

If you have a patient currently enrolled in the Tricare Retiree dental program, they must enroll in a FEDVIP dental plan during open enrollment in order to continue their dental benefits. Their open enrollment period for FEDVIP plans is November 12 – December 10, 2018, with the coverage beginning January 1, 2019.

Click here for more helpful information on the dental plan transition for your Tricare patients.

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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