Delta Dental Network for Dentists

Verify eligibility and benefits electronically through:

• The Dental Office Toolkit — The online Dental Office Toolkit (“DOT”) is available 24/7/365 at no cost to you. Take a few minutes and check out this multi-functional, self-service tool that helps you manage your patients.
• Your practice management system — By automating subscriber/patient eligibility verification through your practice management software, Delta Dental can send you a real-time, HIPAA-compliant transaction (270/271) to immediately obtain enrollment verification and benefits information. Check with your practice management vendor today to see if your system has this capability.

We’ve established a single, dedicated toll-free number exclusively for dental offices. Whenever you need to call Federal Government Programs, simply dial: 844-825-8111.

Use our redesigned interactive voice response (IVR) system to hear automated verification of eligibility and benefits. With the IVR, you can also select the option to have a copy faxed to your office to place in the patient’s chart for future reference.

Use these tips to complete your manual claims and they will be processed more timely and accurately.

DO use:

• A laser printer with black ink
• A 10-point font and all capital letters (Courier is a good font choice)
• Eight-digit dates with no spaces, slashes or dashes (for example, 05032012 for May 3, 2012)
• Fees with decimal points (for example, 100.00; not 100)
• Indicate a quantity (the number of x-rays, for example) in the field on the claim specifically for this purpose. If the claim does not have this field, please list each item on a separate line.
  
  

The following may cause delays, inaccurate processing and possible denials:

• Using free-form text — Use ditto marks or arrows to indicate duplicate information
• Stray marks in spaces that should be left blank
• Putting a slash through zeros or crossing sevens
• Writing on top of lines or outside of boxes
• Using correction fluid or a highlighter pen
• Using more than one font style on a claim
• Submitting photocopied claims as they maybe blurred or skewed
• Using nicknames for either the subscriber or patient
  
  

Other Insurance Coverage

• When the patient has either a FEHB plan or coverage under one of the FEDVIP plans that has any dental coverage, it will always be the PRIMARY carrier. The patient’s OCC dental coverage should be submitted after one or both of the FEHB or FEDVIP coverage has been billed and payment (to include zero) made. In these instances, please simply indicate the amount paid by either carrier (the FEHB and/or FEDVIP) on the claim in the “Other Coverage” area.
• When there is other coverage and it is not FEHB and/or FEDVIP, please indicate that coverage by checking the “Other Coverage” box and be sure to complete all the other information fields in this same area on the claim form.
• In all cases when Delta Dental is the secondary carrier the primary carrier’s Explanation of Benefits or remittance advice is not required; please just indicate the amount paid by the primary carrier on the claim in the “Other Coverage” area.
  
  

Pre-treatment Estimates

If you have submitted a pre-treatment estimate, once services are provided use the notification of pre-treatment estimate form. You only have to date each service, sign and return the form for processing. Line through (single line) any treatment that has not been completed. Do not submit a new claim for any services that have been submitted for a pre-treatment estimate.

Documentation

• Copies of radiographs must be of diagnostic quality.
• We accept duplicate films and paper copies of digital images.
• Radiographs and/or other documentation will not be returned.
  
  

Tax Identification Number (TIN)

The tax identification number you use on your claims affects your year-end 1099 statement. Any changes to this ID number during the year should be verified through your local Delta Dental Member Company no later than the end of each year. No changes to the ID number can be made on the 1099 statements once they have been processed.

The tax identification number and practice name on file with Delta Dental must match the IRS records exactly. If they do not, the IRS requires Delta Dental to withhold 28 percent of the dollars owed to you from future payments until the matter is resolved. Use the tips here when submitting your claims:

• If two or more names are used (such as Chris Smith, DMD, dba Market Street Dental), please give us the first listing that appears on the IRS records, in this example Chris Smith, DMD.
• If you are unsure of how your practice name and the associated ID number are recorded with the IRS, check what is printed on the mailing labels that are supplied by the IRS for quarterly tax payments. Or, you may contact the IRS to request a letter (#147C) that will confirm their records of your name and ID number. The IRS phone number is 800-829-1040.
  
  

National Provider Identifier (NPI)

The federal Health Insurance Portability and Accountability Act (HIPAA) requires you to obtain a NPI if you submit claims electronically. Additionally if you verify claims status or access patient enrollment and/or benefits information online you are required to use a NPI. All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI.

What is an NPI?

• A 10-digit random number unique to each health care provider or organization
• An NPI contains no coded information about the provider or organization
• A permanent identifier that does not change over time or expire
• Not a replacement for social security numbers, DEA numbers, taxpayer ID numbers (TIN or EIN), specialty identifiers (taxonomy) or state license numbers
• Issued by the government through a third-party group, the National Plan & Provider Enumeration System (NPPES), which is responsible for processing applications and assigning numbers
  
  

Which NPI is Right for You — Type 1 or Type 2?

There are two types of NPIs: Type 1 for individual health care providers, such as dentists and hygienists, and Type 2 for incorporated businesses, such as group practices and clinics. When submitting claims, the NPI-1 will always be required for the rendering/treating dentist.

There are various dental programs for the Federal Government, including Federal Employees and Retirees, Veterans Affairs, Office of the Comptroller, and the U.S. Public Health Service Active Duty Dental Program. 

Coverage is offered worldwide, with the Delta Dental Premier Dentist network offered to those residing in the 50 United States, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. With worldwide coverage, members in the programs are able to enjoy access to their dental care regardless of where they live or travel.