|
Frequently Asked Questions Regarding Participation
_______________________________________________________________________
What are the benefits of joining your networks?
Delta Dental of Massachusetts is the largest dental benefits provider in the state—covering over 2 million members through our dental programs. We have three dental networks Delta Dental
Premier, Delta Dental PPO and DeltaCare—these are the foundation of the dental plans we sell. This variety gives our customers three distinct choices when choosing a dental plan—and it gives you three different ways to attract patients to your practice.
And best of all, when you join any of our networks, you get free advertising from Delta Dental of Massachusetts. Not only will your name appear in our printed Directories of Participating Dentists, but you will also be featured in the Find A Dentist section of our Web site.
What types of plans are offered by Delta Dental of Massachusetts?
Click here to view a description of each of our Dental Networks.
Do I have to join all of Delta Dental of Massachusetts' dentist networks?
No. To join in one of our dental networks, you must sign a Participating Dentist's Agreement or Group Practice Agreement for the plan that you wish to join.
Back to Top
_______________________________________________________________________
Is there a charge to join in any of your networks?
Participation is free and all dentists licensed by the state of Massachusetts are eligible to participate. Download a claim form by clicking here (PDF 259K).
Prior to joining a network, how will I know if Delta Dental's reimbursement fees are acceptable to me?
As part of the enrollment process Delta Dental of Massachusetts will provide you with a copy of the appropriate regional fee schedule based on your practice zip code and your dental specialty.
Back to Top
_______________________________________________________________________
Why is it important for Delta Dental of Massachusetts' groups and subscribers to receive care from a participating dentist?
For more than 30 years, Delta Dental of Massachusetts has been dedicated to improving oral health. Because we specialize in dental benefits only, we can offer groups reasonable rates on coverage as well as flexible plan designs. Also, subscribers' out-of-pocket costs are less as they only have to pay their co-payment and/or deductible (if applicable) for services.
I have a group practice. Can each associate participate if we have different fees?
Yes, and checks will be issued to the group practice. All group practices must submit claims with a common tax identification number (TIN) as well as the license number of the dentist who performed the service. Payment will be based on the regional fee schedule that applies based on the practice zip code and the dentist’s specialty.
Back to Top
_______________________________________________________________________
How often are dentist contract fees updated?
Delta Dental of Massachusetts updates dentists’ contract fee schedules annually on January 1st.
How do I talk with a Professional Relations Representative?
Our Professional Relations department is staffed to help answer any questions regarding your network participation or dentist issues. To speak with a Professional Relations Representative, simply call Delta Dental of Massachusetts at (800) 451-1249 x1160 or (617) 886-1160.
What is a pre-treatment estimate?
A pre-treatment estimate is a notification to the dentist and subscriber as to whether the services are covered by the plan contract, and the amount that will be paid provided the subscriber is eligible.
To receive payment, submit a new claim form with the date the service was completed. There is no need to resubmit documentation for the approved procedure, clinical approval is valid for 12 months from the date of issue. PRE-ESTIMATES ARE NOT A GUARANTEE OF PAYMENT. BENEFITS ARE CALCULATED BASED ON CURRENT AVAILABLE BENEFITS AND PATIENT ELIGIBILITY. ESTIMATES ARE SUBJECT TO MODIFICATION BASED ON ELIGILBILITY, COORDINATION OF BENEFITS, THE CONTRACT ALLOWANCE, AND THE BENEFIT PLAN IN EFFECT AT THE TIME SERVICES ARE COMPLETED.
If you have any questions regarding a pre-treatment estimate, please feel free to contact our Customer Service department at 1-800-872-0500.
Back to Top
_______________________________________________________________________
How are claims payments issued to participating dentists?
Claims payments are issued directly to the participating dentist or group dental practice. If the subscriber has a patient responsibility they will receive a copy of the Explanation Of Benefits (EOB) which summarizes the services they received, the amount Delta Dental paid, and their co-payment and/or deductible (if applicable). Checks are issued on a weekly basis and will include payment for all claims processed during that check cycle along with copies of your patients' EOB.
How long does it take Delta Dental of Massachusetts to process a claim?
Over 90% of routine claims processed through normal processing channels are paid in less than 15 business days if they are complete and eligibility can be verified.
How do I start submitting electronic claims?
Contact your practice management software system vendor and discuss your interest in Electronic Claims Submission (ECS). They will help your office become ECS ready and establish a link between your office and an electronic claims clearing house whose function is to transmit your electronic claims to all the insurance carriers you do business with.
Back to Top
_______________________________________________________________________
Do dentists make decisions on claims or do auditing personnel do this?
Most claims submitted to Delta Dental of Massachusetts can be processed directly by our automated claims system. However, professional judgment may be required to determine benefits for certain types of treatment. These claims are referred to our Dental Case Management area—which consists of licensed dentists and dental professionals who review claims to determine benefits in accordance with dental contracts.
Does Delta Dental of Massachusetts conduct office billing audits?
Delta Dental of Massachusetts currently conducts office billing audits on a random basis to assure appropriate claim submissions. An office may be selected if there is reason to believe a participating dentist is violating his or her agreement with Delta Dental of Massachusetts.
Back to Top
_______________________________________________________________________
|
