A Guide to Delta Dental's Network
Delta Dental Premier and Delta Dental Premier with National Coverage
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.
Reimbursement for Delta Dental Premier patients is based on a regional fee schedule. Individual fee allowances are referred to as contract fees. When you enroll in the Delta Dental Premier network, you agree to accept your contract fee as payment in full for eligible Delta Dental members.
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Delta Dental PPO, Delta Dental PPO with National Coverage and Delta Dental PPO Plus Premier
Delta Dental PPO is our preferred provider
organization. Reimbursement is based on a regional fee schedule which is reviewed annually.
According to the National Association of
Dental Plans, dental PPOs are the fastest growing plans.
In the NADP/DDPA 2010 Dental Benefits Enrollment study they found
that national PPO enrollment now comprises 69% of all commercial
dental benefits reported. 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 three 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.
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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 their dental care. We limit the number of
dentists in each geographic area so that we can guarantee adequate patient
flow to the dentists in the network
Primary care dentists are reimbursed through a
combination of fixed monthly capitation payments, lab fee supplements,
specialty payments, and member co-payments that are collected directly
from the patient. As a participating DeltaCare PCD, you receive a fixed
monthly fee for each of your DeltaCare patients regardless of whether the
patient receives treatment from you in a given month. Specialty services
are reimbursed based on the appropriate regional Delta Dental PPO fee
schedule for the treating dentist’s specialty.
Like the Delta Dental PPO network, all DeltaCare
participating dentists are credentialed every three years according to
the guidelines established by the National Committee for Quality Assurance (NCQA).
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