Orthodontic Processing - FAQs
Frequently Asked Questions
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Why did Delta Dental change the way they pay orthodontic claims?
This change allows us to be compliant with HIPAA required CDT-4 codes, and to be more efficient and accurate in our processing of orthodontic claims.
Will the amount that I am reimbursed change?
No, the amount we reimburse will not change. The change will occur in the process we use to pay orthodontic claims. Payments will be calculated in monthly installments, up to the maximum allowable benefit, not to exceed 12 installments.
What happens if the treatment lasts longer than 24 months?
In most cases, Delta Dental bases its calculations for comprehensive treatment on the total case fee regardless of the length of treatment. Exceptions are listed on the attached Orthodontic Exception Group summary.
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Will limited Ortho be paid the same way?
Payments will be calculated in monthly installments, up to the maximum allowable benefit, not to exceed 6 installments with the exception of services under $500, which will be reimbursed in a single payment.
How will I know the amount I will receive on a monthly basis?
Once the patient has begun treatment, submit your claim to Delta Dental. Your claim will then be calculated in monthly installments, up to the maximum allowable benefit, not to exceed 12 installments. You will receive a pre-estimate, which will display line-by-line the monthly payment amounts you will receive for that patient. If the patient has not yet begun treatment, you may submit a pre-estimate for a monthly breakdown. You must then resubmit the processed pre-estimate with the date of service to initiate payment. Automatic monthly payments will be generated by the final check run of each month.
Why is a 5% discount taken?
Delta Dental's payments are subjected to a 5% discount, as allowed under Massachusetts General Laws, chapter 176E. This legislated discount cannot be collected from the patient, and Delta Dental of Massachusetts does not retain it. Rather, it is passed on to the consumer in the form of a discount. The 5% discount will be deducted from each monthly payment amount until the patient reaches their final lifetime maximum benefit payment. At the time when the patient reaches their final lifetime maximum benefit, no 5% discount will be taken.
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When did this new payment process go into effect?
Cases in which the first payment has been made BEFORE June 1, 2003 will be reimbursed with the previous process. Cases in which the first payment will be made AFTER 6/1/03 will be reimbursed with the new process. Groups that require special processing methods are detailed on the attached exception list.
Did Delta Dental communicate this new method of payment to my patients?
If the first payment will be made AFTER June 1, 2003 the new payment process will be reflected on the EOB and pre-estimates that are sent to the patient. However, no formal explanation of this change will be communicated directly to orthodontic members because it does not impact their orthodontic benefit.
What if a patient's treatment is discontinued?
If a patient discontinues treatment, you must notify us in writing with the final treatment date so we can discontinue the automatic monthly payments.
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How will this affect orthodontic claims that are submitted electronically?
The claims submittal process remains the same for claims submitted electronically.
How should my office submit for records?
Records are considered part of the total case fee. However, Delta Dental will pay for records separately under procedure code 8660 in the event the patient is not proceeding with treatment.
How does this change effect any financial agreement that I have established with my patient?
Delta Dental's new payment process has no impact on the manner in which you collect patient payments for any plan deductibles, coinsurance, and any non-covered services.
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