What is National Coverage?
National Coverage is a program under which Delta Dentals from around the country work together to offer the advantages of a local Delta Dental network to organizations that have subscribers in more than one state. There are 37 independent Delta Dentals operating in all 50 states, the District of Columbia and Puerto Rico. National Coverage was created by the Delta Dentals Associations Board of Directors in 1989 to address the needs of companies with employees in multiple states. Today, it has grown into a national umbrella program through which Delta Dental delivers three types of dental benefits programs: a traditional fee-for-service program (Delta Dental Premier with National Coverage), a preferred-dentist program (Delta Dental PPO with National Coverage) and a capitated plan (DeltaCare USA).
As a participating dentist you also join National Coverage
When you sign a participating dentist's agreement or a participating group practice agreement for a particular Delta Dental of Massachusetts network, you also agree to participate in the corresponding National Coverage plan. For example, when you participate in the Delta Dental Premier program, you automatically participate in the Delta Dental Premier with National Coverage program too.
Under the National Coverage program, you are a member of a nationwide network of dentists. Being a member of the network offers great advantage to you. Patients receiving benefits covered by Delta Dental in another state, seek out local participating dentists for care. This can mean more business for your practice.
Claims Processing Under National Coverage
Claims for your National Coverage patients are processed by the regional control plan based on the location of the groups' corporate headquarters. The control plan for the patients' group is identified on his or her ID card (click here for a listing of National Coverage plans and their addresses). Treating dental offices complete Delta Dental claim forms and submit them to the control plan handling the group account under which the patient is covered. National Coverage patients are responsible for any applicable co-payments, deductibles, services not covered and amounts exceeding their annual plan maximum.
Claims submitted for services performed on your National Coverage patients will be processed based on national processing policies. Click here to view the Processing Policies & Procedures Reference Guide for a complete list of the local and national account processing policies.
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