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. 

Delta Dental’s Statement On Opioids

January 03, 2018

As healthcare providers licensed to provide prescription medications, dentists must educate themselves about safe and responsible prescribing as well as identify potential abuse by their patients. Opioids are commonly prescribed by the medical and dental professions to relieve pain. There is a widely publicized opioid epidemic. According to the Center for Disease Control and Prevention (CDC), out of the 52.404 lethal drug overdoses in 2015, opioids accounted for 20,101 deaths, over 38 percent. The CDC also advises that overdose is not the only risk related to prescription opioids. Misuse, abuse, and opioid use disorder (addiction) are also potential dangers. As prescribers of opioids, dentists and the dental profession, have a role in preventing their misuse. As the nation’s leading dental benefits provider, covering more than 73 million Americans, and offering the country’s largest dental network with roughly 152,000 participating dentists, Delta Dental recommends the following industry norms to better manage the prescribing of opioids. 

  • When considering prescribing opioids, dentists should conduct a thorough medical and dental history, including documentation of current medications taken.
  • Dentists should consider treatment options that utilize best practices to prevent exacerbation of, or relapse of, opioid misuse.
  • Dentists should consider using alternative treatments such as non-steroidal anti-inflammatory drugs (NSAIDS) which are effective in relieving postoperative dental pain, have fewer side effects and less potential for abuse compared to opioids.

If opioids are prescribed, the dose and duration should be for as short a period as possible. Dentists should follow CDC guidelines, such as the lowest possible effective dosage and start with immediate-release opioids instead of extended-release/long-acting opioids. Dentists should have a discussion with patients regarding the risks and complications of any medications they prescribe, including opioids. The patient should also be instructed on responsible storage and disposal of prescription opioids and the potential for misuse and abuse. Safe disposal instructions should be given to patients to ensure unused medications are not misused or improperly disposed of.

Dentists should follow and continually review CDC guidelines as well as their State Licensing Board recommendations for safe opioid prescribing. 

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.

Contact Us Through Our

Online Form

View Our