Treatment Notes: Why We’re Asking For Them & Why They’re Important

July 08, 2018

In 2018, there has been a renewed emphasis in the Delta Dental National Processing Policy on the importance of treatment/clinical notes over narratives when submitting explanations on your predeterminations and claims. Treatment/clinical notes are considered a legal document, while narratives are not. The Processing Policy now states that “the only acceptable legal written documentation for utilization review are the contemporaneous treatment notes”. 

We appreciate your cooperation as we continue to request treatment notes over narratives. If you have any questions about this policy, the Professional Relations Team is happy to speak with you.

Delta Dental Of Kansas Is Offering Members Access To Independent Dentist Reviews On Healthgrades®

July 06, 2018

What is Healthgrades®?

Healthgrades® offers information on health care providers as a free service to consumers, patients and other health care professionals. Healthgrades aggregates information related to provider practices from publicly available sources.

How do I get more information?

If you would like to learn more about your Healthgrades® provider profile, click here.

Periodontal Maintenance Changes

April 12, 2018

We have listened to your feedback and have eased our policy on processing periodontal maintenance claims for patients who have had a lapse in treatment.

Delta Dental of Kansas (DDKS) Periodontal Maintenance Policy Changes as of 2/20/18:

  • DDKS will no longer request periodontal history within the last 24 months for 4910 periodontal maintenance. 
  • The system is now looking for history of paid procedure codes 4240, 4241, 4260, 4261, 4341, 4342 &/or 4910 within the patient’s lifetime.
  • If PAID history is found, the 4910 will automatically process as submitted.
  • If no history is found, such as in the case of a patient with a new DDKS policy, a letter requesting additional information will be sent to the provider asking for chart notes documenting previous periodontal history and maintenance. Please send the chart notes for the original periodontal surgery or SRP and the last few D4910 perio maintenance visits.

If you have questions, please contact your Professional Relations Representative

Predeterminations Now Valid For 6 Months

April 11, 2018

We have listened to your suggestions and have extended the period of time that predeterminations are valid. If the predetermination on file is nearing its expiration date, contact customer service to request and extension.

When Are Predeterminations Mandatory?

April 10, 2018

Are you aware that predeterminations with a current “valid to” date are mandatory for some procedures under some group dental plans? When mandatory, it is usually for treatment plans that involve implants, TMJ/TMD and bruxism. Predeterminations are required by some plans in an effort to reduce surprises for your patients when it comes to out-of-pocket costs. Please verify that a valid predetermination is in your possession before beginning treatment on your patient. A few examples of some of the group plans that require a predetermination on implants: 

  • Delta Dental Individual and Family℠ Platinum Plan Platinum Plan
  • USD #259 — Wichita — Buy-Up
  • CURO Management LLC
  • WCNOC-Union-IBEW / Non-Union / Ret
  • Shawnee County
  • Kansas Building Trades
  • Security Benefit Corp
  • Newton Medical Center
  • Shamrock Trading Company
  • Berry’s Arctic Ice LLC
  • Bartlett and West
  • Kansas Turnpike Authority 
  • LRICO Services

While the patient bears responsibility for knowing his or her dental benefits and requirements for predeterminations, many patients rely on their dental office to assist them. If you are unsure whether or not a predetermination is mandatory, please review the patient’s benefits by logging into your dentist account or contact us

Requests for predeterminations are made by submitting a proposed treatment in the same manner as a regular claim, omitting dates of service and the dentist’s signature. We strongly encourage dentists to make predeterminations a habit for all treatments with costs in excess of $250 (whether mandatory or not), except in emergency and routine situations. For additional details, please review the “What You Need to Know” section of the Participating Dentist Handbook by logging into your dentist account.

National EFT/ERA Update & Tips

April 07, 2018

Full implementation of the national EFT/ERA program is complete and Delta Dental Member Companies currently making direct deposit payments are displaying your remittance advices on the DentalXChange (DxC) platform. You will no longer need to access separate website to obtain ERAs!

Tips on using DxC:

  • Some, but not all, Delta Dental Member Companies are sending email notifications when new EFT payments are made. We recommend you log in to your Delta Dental of Kansas dentist account each morning, check your local remittance and then check DxC for new ERAs for other Member Companies rather than rely on email notification. 
  • DentalXChange updated their advanced search function. Please note that currently, the process type is set to “Unprocessed”. If you are searching for a claim that has already paid, first change the processed type to “Previously Processed”, enter the identifying information in one or more of the payment or claim information and then click “Search”. 

Processing Policy Change Reminder

January 12, 2018

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 image, with or without supplemental radiographic image (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 not billable to the patient”. 

2018 Delta Dental PPOSM Fee Schedule

January 10, 2018

The 2018 Delta Dental PPO Fee Schedule is available within your online dentist account. You will find the fee schedule within the “Documents and Dentist Handbook” section. 

Please note, Delta Dental’s PPO program is an optional program for participating dentists with a separate contract. Participation in this program offers you access to a larger number of Delta Dental patients. Contact your local Professional Relations Representative if you would like to participate in or learn more about the PPO network.

2018 Participating Dentist’s Handbook

January 07, 2018

The 2018 Delta Dental Participating Dentist’s Handbook with Processing Policies and Procedures Reference Guide is also available within your online dentist account. You will find the handbook within the “Documents & Dentist Handbook” section within the portal. You will find the handy “What You Need to Know” section at the beginning of the handbook. This section includes topics such as guidelines for submitting claims and predeterminations, how to submit orthodontic claims, how to handle coordination of benefits, how to handle appeals, information about electronic services and more. 

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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