A Guide to Delta Dental's Network
Delta Dental Premier and Delta Dental Premier with National Coverage (Formerly known as DeltaPremier and DeltaPremier USA)
Delta Dental Premier is our traditional fee-for-service
dental program. Close to 96% of the state's licensed dentists
participate in Delta Dental Premier. Although managed care plans are
gaining in popularity, Delta Dental Premier remains our most popular
plan.
Your reimbursement for Delta Dental Premier patients
is based on your fee profile. When you enroll in the Delta Dental Premier
network, you file your usual fees for the procedures you perform.
If those fees fall within our customary range, they are accepted
as is and become your "usual fee profile." If any of your
filed fees are above the customary maximum, your Delta Dental allowance
will be limited to the maximum allowable amount. Each individual
dentist's or group practices' fee profile is reviewed twice
a year and updated every April 1st and October 1st based on
the fees you submit on claims during a prior six-month study.
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Delta Dental PPO, Delta Dental PPO with National Coverage and Delta Dental PPO Plus Premier (Formerly known as Delta Preferred Option Plus)
Delta Dental PPO is our preferred provider
organization. Our goal is to maintain a network of at
least 25% of the state's practicing dentists. Reimbursement
is based on a set fee schedule or Table of Allowance, which
is reviewed annually.
According to the National Association of
Dental Plans, dental PPOs are the fastest growing plans. In
their study they found that national PPO enrollment increased
from 17% in 1997 to 29% in 1999.* In addition to helping you
increase your patient base, enrolling in the Delta Dental PPO network may help you retain existing patients who become
covered by a PPO plan.
Delta Dental PPO dentists are credentialed
according to the guidelines established by the National Committee
for Quality Assurance (NCQA) and are recredentialed every
two years. What this means for you is a free onsite personal
consultation with a licensed hygienist from our Professional
Relations Staff. During this visit, our hygienists can talk
to you about infection control, sterilization, patient record
keeping, claim filing and more — information to help you run
a successful and profitable dental practice. To see some of
the commonly asked questions regarding the Delta Dental PPO network, please click
here.
*Source: NADP 1999 findings extrapolated
from February 2000 NADP update, Business & Health, March 2000
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DeltaCare and DeltaCare USA
DeltaCare is our managed care, capitation
plan. Members choose a Primary Care Dentist (PCD) from our
network of DeltaCare participating dentists to manage all
of their dental care — including referrals to specialists. DeltaCare
dentists enjoy a dedicated customer service unit that handles
all their eligibility, benefit, reimbursement, and dentist
relations' issues. We limit the number of dentists in each
geographic area so that we can guarantee adequate patient
flow to the dentists in the network.
DeltaCare is among the highest dentist reimbursement
of any capitation plan in the state. Primary care dentists
are reimbursed through a combination of fixed monthly payments,
lab fee supplements, specialty payments, and member co-payments
that are collected at the time of the patient's visit. As
a participating DeltaCare dentist, you receive a fixed monthly
fee for each of your DeltaCare patients regardless of whether
or not the patient receives treatment from you in a given
month. Specialty services are reimbursed based on the Delta Dental PPO table of allowance.
And, to ensure that you are being adequately
compensated for the care you deliver to our DeltaCare members,
we've created the Provider Protection Plan (PPP). The PPP
guarantees that if your reimbursement (from the combination
of the monthly capitation payments, member co-payments, lab
fees, and specialty payments) falls below a certain level — you
will be paid the difference. To see some of the commonly asked
questions regarding DeltaCare, please
click here.
Like the Delta Dental PPO network,
all DeltaCare participating dentists are credentialed every
two years according to the guidelines established by the National
Committee for Quality Assurance (NCQA).
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