Orthodontic Processing - How To Report Ortho Services
Delta Dental of Massachusetts is processing orthodontic benefit payments using a monthly payment method (not to exceed 12 installments). Calculation of orthodontic benefits is made based on the all-inclusive total case fee, and is subject to deductibles (if any), 5% Massachusetts Delta discount, appropriate co-payment percentage, and a patient's lifetime orthodontic maximum.
SUBMITTING THE INITIAL ORTHODONTIC CLAIM
When submitting the initial orthodontic claim, you must do the following:
- Apply the CDT-2005 procedure code that best describes the type of care the patient is receiving.
- Specify your total case fee, including all records, retention, and retainer fees (all inclusive).
- Indicate the estimated length of treatment.
- Indicate the class of malocclusion.
- Indicate the initial banding date.
PAYMENT PROCESS
Delta Dental will make the initial monthly payment and will send you a CEOB describing this payment. Under a separate cover, you will receive a pre-estimate listing the remaining monthly payment amounts-line by line-up to the amount when the allowable orthodontic benefit is met.
Please note that the 5% discount will be deducted from each monthly payment amount until the patient reaches their final lifetime maximum benefit payment. Once the patient reaches their final lifetime maximum benefit, no 5% discount will be taken.
SUBSEQUENT MONTHLY PAYMENTS
Automatic monthly payments will be generated until the patient's allowable benefits have been met, or until you notify us that the patient is no longer receiving care in your office.
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