Box 1810 Read our Fact Sheet to learn more: Smiles for Children Member Brochure (Spanish), Smiles for Children Adult Dental Benefit FAQs, Adult Dental Services for Virginia Medicaid Members - Webinar, Adult Dental Services for Virginia Medicaid Members - Slide Deck Announcing Benefit, Adult Dental Services for Virginia Medicaid Members - Slide Deck Announcing Benefit (Spanish). Retainer Boxes |
Dental Finishing Supplies |
Fee discounts (including waiver of copayment/coinsurance) should be reflected in the total fee that is entered on the claim. contain certain exclusions and limitations. Dental Preventive Products |
Simply log in to your Provider Tools account (or register if you have not already done so) and use the Eligibility and Benefits tool. These updates are required to be filed first for approval by state regulatory agencies in many locales. Photographs must accompany radiographs when determining cracked teeth, build-ups, crowns, and anterior restorations when evidence of necessity is not obvious on the radiographs. Contact your company's human resources department. 465 Medford Street, Ste 400. To check that your provider participates, visit our website or call us. Currently, the tool provides the total cost of the procedure; however, in the near future it will also show Delta Dental subscribers their actual out-of-pocket costs. Specialists and general dentists recorded the fees they charged most often for over 200 dental procedures. Like most dental benefit plans, MetLife's dental plans
Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. Do not avoid getting dental care based on the cost information provided on this website. Include all required x-rays, documentation and/or written narratives. to claim your profile. * All pre-treatment radiographs, photographs and charting should be within 12 months of the planned treatment unless otherwise specified. No. Delta Dental Properly balance your fee schedule to a given percentile to ensure your practice remains competitive in an everchanging dental marketplace. Therefore, it is always best to confirm information with yourhealth careprofessionals. Send it to your local Delta Dental by e-mail, fax or U.S. mail: E-mail:dentist_services@delta.org Is keeping employees healthy and productive one of your priorities? Enter city and state to see all the ZIP Codes for that city. "Delta Dental" refers to the national network of 39 independent Delta Dental companies that provide dental insurance. to beginning treatment. How much is it going to cost? Dental Evacuation |
We have coverage options designed to fit your business. By entering $80 on the claim, you ensure that Delta Dental calculates its payment based on the fee actually charged, as required under the terms of your agreement with Delta Dental. Rubber Dam | Rubber Dam Clamps |
If it is not, include a written narrative so that the dental consultant will understand the purpose of the crown. You can submit a request for a claimadjustment. Narratives must also be maintained as part of the patient treatment record. Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. To expedite the processing of your claim, utilize the requirements below to identify the necessary documentation and/or clinical information required for review of specific procedure codes. Dental Scalers, Power Scaler & Dental Curettes |
The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan. When Delta Dental is secondary in dual coverage cases, please include the primary coverages total liability including copayment/coinsurance percentage and the explanation of benefits (EOB). your dental service provider's fees and is for informational purposes only. Tubing Suction Connect |
D3310-D3330, D3921. Cost estimates for services provided by out-of-network dentists (available in the out-of-network estimator) are based upon submitted claims data for out-of-network providers. Dental Periodontic Products |
Daniel Ribeiro , has not yet specified details about his residency. Claims will be processed when received according to your plan provisions. Do not avoid getting dental care based on the cost information provided on this website. Please note that this fee
1The [Price Without Plan] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Look at you smiling. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at 1-888-632-5353 with the ADA Code of the procedure and we can provide the discounted fee. Mechanicsburg, PA 17055. The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what dental benefits your plan will cover, or your out-of-pocket costs. *Not sure where your company is headquartered? Latex Free Exam Gloves |
Your National Provider Identifier (NPI) is an important number for all providers to have in order to successfully submit claims with Delta Dental. This cost estimator is intended for use in the 50 states, Puerto Rico and other U.S. territories. For a complete description of the details of your coverage, please refer to your coverage documents. 2 Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. *Not sure where your company is headquartered? Also, medical coverage would be primary if the group dental plan contract indicates that specific oral procedures are covered (such as a biopsy, oral surgery provided by a physician or dental treatment provided in a hospital). Check out Virtual Consult, Check out our new DeltaVision plans We do not return radiographic images or other documentation submitted with paper claims; however, we will make an exception when we receive a stamped, self-addressed envelope with the claim. than what is displayed. Provisional splinting, Description of service: Box 6059 . Delta Dental and its affiliate companies use MetaVance Benefit Administration Software as the claims editing software product to provide timely and efficient adjudication for dental claims. Use new claim forms that accommodate the NPI by providing a specific space for it. By submitting your information, you are agreeing to receive communications from DentalPlans.com. Department of Medical Assistance Services. We often hear Henry Schein customers state that they arent concerned with balancing UCR fees because they participate with various dental benefit providers. Maximize your oral health and make the most of your dental benefits right from your mobile device by downloading the Delta Dental Mobile App. First, select the patient. Please scroll down and accept to proceed. Periodontics (including scaling and root planing) Bitewing radiographs. In joint custody cases, the parent Maximum contract allowances will differ by 5-digit ZIP code. Photocopied claims that are blurred or skewed. The national network of Delta Dental companies protects more smiles than any other insurance company. Want to know before you set foot in the dentists office? Complete the claim information, select Continue, then Submit Claim. The sample table above is a small selection of common procedures discounted by these discount dental plans and programs. If you live outside the U.S., you may see information on this cost estimator about products or services that are not available or authorized in your country. ), Birth date for the patient and eachmember, If parents are divorced, the parent with whom the child lives, When Delta Dental is the secondary carrier, Explanation of Benefits (EOB) from the primary carrier. Latex Exam Gloves |
Please scroll down and accept to proceed. Enter a ZIP Code to see the cities it covers. Here are some suggestions to speed up claim payments. Box 2106, Mechanicsburg, PA 17055. Refer to your benefit plan to determine whether preventive services are covered for you. Balance your fees before negotiating your PPO reimbursement contracts. Delta Dental may also terminate the dentists participation agreement if a dentist regularly waives patient copayments. the START SEARCH button thats all you need! Charges for clear aligners (e.g., Invisalign, SureSmile) should be submitted using theappropriate orthodontic procedure code (D8010-D8090). You have entered an Invalid User ID and/or Password. Lack of sufficient information, especially themembers ID number, is the most common reason for a delayed or denied claim. For javascript disabled viewers -
Protect my smile Dental procedures When do you need a root canal? Contact DentaQuest at 1-888-912-3456 or search the DentaQuest website to find a listing of dentists who accept Medicaid in your zip code. This website shows estimates of certain dental care costs. Do not submit documentation with other procedures (unless Delta Dental specifically requests it). Please contact the Delta Dental company below for more information. If there is any conflict or discrepancy between the Content on this website and your coverage documents, your coverage documents will control. Health information changes quickly. You should update your fees at least annually. However, some health plans may choose to require NPIs on all transactions. You will be notified separately when processing of secondary coverage is completed. This software helps our enterprise streamline many interrelated systems and processes, as well as increase functionality for the benefit of our dentists, members and clients. Include all patient information on claims. Preventive care coverage varies by plan and by demographic considerations such as age. U. S. Mail:Delta Dental Insurance Company,ATTN: Provider Onboarding, P.O. Example:If you provide treatment for erosion, theres a good chance the claim cannot be paid because erosion is a common exclusion under most dental plans. Any additional fee for the nontraditionalmethod is not billable to the patient. The federal Health Insurance Portability and Accountability Act (HIPAA) requires you to obtain an NPI if you submit claims electronically or if you check claims status or access patient eligibility and benefits information online. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. How maximum contract allowances are determined, How maximum contract allowances are updated.
If you receive notification that no payment was made because of late submission: Amounts due from Delta Dental may be paid to your professional corporation, partnership or association. 157 0 obj
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The SFC program is managed by Dentaquest. DentalPlans detailed profile of Daniel Ribeiro , DDS - Dentist in 20152. View plans, sample savings & pricing, patient reviews & practice information. E-mail:customerservice@npienumerator.com, Telephone:800-465-3203 / 800-692-2326 (NPI TTY), Mail:NPI Enumerator The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what services your dental benefits plan will cover or your out-of-pocket costs. fees when you pay. Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patients: At any time, you can review the patients current eligibility and benefits information, including remaining maximum and deductible amounts. Connect with your Delta Dental company to learn more. Dual coveragerefers to when a patient's dental treatment is covered by more than one dental benefits plan. These plans are not considered to be qualified health plans under the . Simplylog in to Provider Toolsand select "My claims." The dental provider listings on DentalPlans.com are provided directly from each dental network or discount dental plan, which are responsible for their accuracy and completeness. The costs provided in this tool are estimates only and are not a guarantee of payment or benefits. a patients eligibility and benefits will only be determined at the time of a claim
Next, under Type of Transaction, choose Pre-Treatment Estimate. Health information changes quickly. its provided. Estimates may vary depending on your benefit plan and the state you live in. Dental Infection Control Supplies & Products |
Actual fees charged by your provider may vary for a variety of reasons. When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patients most current eligibility and benefits to determine payment. Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. Type in the zip code of your choice and balance your fees right from the start! DELTA DENTAL PATIENT DIRECT GENERAL DENTIST FEE SCHEDULE ALL PROCEDURES Effective from 06/01/2022 D2712 Crown - Resin-Based Composite (Indirect) $305 D2720 Crown - Resin With High Noble Metal $648 D2721 Crown - Resin With Predominantly Base Metal $561 D2722 Crown - Resin With Noble Metal $625 D2740 Crown - Porcelain/Ceramic $725 Privacy Statement Terms of Use Social Media Policy, I receive dental insurance through my employer, I receive dental insurance via my employer, The 2022 State of Americas Oral Health and Wellness Report, Sports mouth guards to protect against dental injuries. This is a10-digit random number unique to each health care provider or organization. Notes: Therefore, it is always best to confirm information with yourhealth careprofessionals. November 2018 Page 1 . Complete the application and follow instructions to submit either online or by mail. %PDF-1.6
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*Not sure where your company is headquartered? Fax: 717-774-1770 Generally, Delta Dental allows one reevaluation per claim. MHCP Fee Schedule (MHCP Fee Schedule (dental codes begin on page 55 of the PDF) Fraud, Waste, and Abuse: Combating Medicare Parts C and D Fraud, Waste and Abuse Training Web Based Training Course 2022; Click the ">" to move your selection to the box on the right side. Six-digit dates with no spaces, slashes or dashes (for example, 120320 for December 3, 2020). To begin using the Dental Care Cost Estimator tool, click the Agree button below. Example:If your fee for a service is $100 and you wish to give the patient a 20% discount, then $80 becomes the fee that is actually charged and $80 should be entered on the claim as the total fee. The fee schedules are typically part of the participating provider agreement - a legal contract between the dentist and the third-party payer. Dental Patient Education | Dental Patient Communications |
Vinyl Polysiloxane (VPS) Dental Impression Material |
However, specific plan provisions may dictate differently how dual coverage will be determined, so it is a good idea to check the member's Evidence of Coverage for details. This is important because some services may be included in the patients basic coverage, even if the patient does not have specific orthodontic coverage. Start quoting dental + vision plans for small business. The description of different treatment categories, and the inclusion of particular services in a treatmentcategory,is not advice that any particular treatment category is the right treatment for you or that you should not obtain any particular treatment. Oral surgery (excision of lesion), Procedure codes: Note not all plans and A full time job and a part time job: Coverage through the full time job is primary. 2018 MetLife Services and Solutions, LLC. Delta Dental recommends that the NPI be used on all claims. Enter a corporate or residential street address, city, and state to see a specific ZIP Code . The AMA assumes no liability for data contained or not contained herein. Dual coverage with the same Delta Dental company, California rule for coordination of benefits, How to request a real-time pre-treatment estimate, What to include on an orthodontics treatment claim. X, 19Ys = L
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Dental Reminder Postcards and Filing Office Supplies |
Look Up a ZIP Code . P.O. Writing on top of lines or outside of boxes. Learn more about how you can use Smiles for Children insurance. Equipment & Technology Financing & Leasing, Henry Schein Thrive Rewards Terms & Conditions, Articulating Paper for Occlusal Contacts & Forces, Cosmetic Dentistry: Teeth Whitening & Alignment, Dental Adhesives: Dental Cements & Dental Liners, Dental Alloy: Dental Amalgam & Dental Refining, Dental Cements - Temporary & Permanent - Dental Liners, Dental CAD/CAM: Dental CAD/CAM Milling Machine, Dental Continuing Education Seminars & Resources, Dental Digital Radiography & Digital X-Ray Equipment, Dental Equipment Parts - Dental Repair Parts, Dental Handpieces & Dental Handpiece Repair, Dental Infection Control Supplies & Products, Dental Tools & Instruments - Hand & Surgical Instruments, Dental Materials: Dental Equipment & Technology, Dental Office Dcor Reception Room Furniture, Dental Office Forms - Perio Charting Forms, Dental Patient Education | Dental Patient Communications, Dental Patient Financing | Dental Financing, Dental Polishing: Finishing Strips, Polish & Brushes, Dental & Porcelain Veneers: Dental Laminates, Dental Practice Marketing & Office Supplies, Dental Reminder Postcards and Filing Office Supplies, Dental Restoration: Dental Bridges, Crowns & Posts, Dental Scalers, Power Scaler & Dental Curettes, Dental Sleep Medicine - Sleep Apnea Prevention, Dental Scrubs & Uniforms - Fashion Seal Scrubs, Disposable Dental Supplies - Single Use Products, National Dental Supply and Dental Products Manufacturers, Online Dental Supply Company | Dental Supply Store | Dental Companies, Oral Cancer Screening Light Tool | Identafi, Oral Surgery Instruments, Anesthetic & Supplies, Preventive Products: GC MI Paste Plus, Colgate PreviDent, PreviDent, Sharps Disposal Containers - Small & Large Sizes, TechCentral - Advanced Technology Solutions and Dental IT Support, Vinyl Polysiloxane (VPS) Dental Impression Material. Members have a fixed copayment for all covered services and cannot be balance billed. Connect with your Delta Dental to learn more. The patient is responsible for their coinsurance/copayment portion only. Consult with your provider prior to beginning any treatment. After you register, claim your free Doctor.com profile to expand your reach online. Save time and money while helping the environment by electronically submitting your encounter forms to DeltaCare USA. Use your FastAttach connection, a service available through NEA, to electronically transmit digitizedx-rays, narratives, intra-oral pictures, Explanation of Benefits (EOB) Statements or any other document needed to adjudicate the claim. Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah and U.S. Virgin Islands: E-mail:ProfessionalServices@ddic.delta.org Pediatric Dental Supplies & Instruments |
Every 12 months you may submit separate Delta Dental Premierfee updates for each practice location, specialty and TIN. Delta Dental reviews allowances on an ongoing basis. For example, if a retiree is employed, the active coverage is primary; the coverage resulting from retirement is secondary. Dental Practice Marketing & Office Supplies |
Only the procedure codes listed below always require the submission of documentation with claims for your Delta Dental Premier and Dental PPO patients. Dental Supplies & Specialty Products |
Waiving copayments violates the contracted dentists participation agreement with Delta Dental as well as the patients dental benefits contract. The secure version (available only after you sign in) uses procedure costs or cost ranges as reflected in provider fee schedules and aggregated historical cost data. P.O. None of the information on this website represents or warrants that any particular drug or treatment is safe, appropriate or effective for you. Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. If the claim does not have this field, please list each item on a separate line. Universal Composites |
Actual fees charged by your provider may vary for a variety of reasons. Thoroughly complete the claim with clear, legible information. All of those matters are things that you should decide, in consultation with your dental care professionals. Fax: 617-886-1414. For DeltaCare USA, maximum contract allowances are not applicable. Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. An itemized Explanation of Benefits is required for all procedures when Delta Dental is the secondarycarrier. Also, this will help ensure that Delta Dentals calculation of the patients portion takes into account all available benefit information. Dental Equipment Parts - Dental Repair Parts |
Core buildup, including any pins, Description of service: Want to know before you set foot in the dentists office? Document exceptional or unusual circumstances only in the Remarks or Comments field of the claim. To obtain your NPI, simply go to theNational Plan and Provider Enumeration System (NPPES) and follow the instructions to complete the application. Estimates should not be construed as financial or medical advice. Always notify Delta Dental of the actual fee charged. P.C., (Adam Diasti, DDS, DN11634) or Coast Dental of Texas, PC (Adam Diasti, DDS, Lic 32327) Coast Dental Services, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. A patient may have dual coverage through the same Delta Dental company (for example, your patient may have her own Delta Dental of California coverage and also be covered as a spouse through her husbands plan, which is also a Delta Dental of California plan). Some Delta Dental groups that are not subject to the provisions of California Health and Safety Code 1374.19 have a non-duplication of benefits clause in their contract. AED Units and Defibrillator Products |
Delaware, District of Columbia, Maryland, New York, Pennsylvania and West Virginia: E-mail:ddpdentist_services@deltadentalpa.org For assistance call 1-800-372-4346, 8:00am-8:00pm ET. Daniel Ribeiro , Dentist has not yet specified details about his residency. Verify that the dentist is your selected DeltaCare USA primary care dentist before each appointment. Privacy Statement Terms of Use Social Media Policy. Connect with your Delta Dental company to learn more. Such clauses means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist. Once you're a member, you will be provided with a complete fee schedule (applicable for most plans) with discounted fees for nearly every dental procedure. Example:If the dentist submits a fee on a claim for $120, and the maximum contract allowance is $100, Delta Dental will calculate its payment and the patients payment based on $100. How will the NPI affect other numbers I've used in the past? The version of the Cost Estimator that is available publicly (does not require sign-in credentials) uses aggregated historical cost data for the procedure in question. You will receive the discount off the providers usual and customary The secure version (available only after you sign in) uses procedure costs or cost ranges as reflected in provider fee schedules and aggregated historical cost data. the latest UCR update for all ADA codes July 1. Survey of Dental Fees This exclusive survey provides you with an analysis of self-reported fees by procedure from a nationwide, random sample of dentists.
Your actual cost may be higher or lower than the estimate for various reasons. Using correction fluid or a highlighter pen. Click View contracted fee reports 2. Dental consultants are licensed dentists, who share your depth of knowledge about dental treatment and disease. App features may vary by geographic area and individual dentist participation. Pre-treatment estimates are especially beneficial when expensive or extensive treatment is being considered and/or dental plan annual maximum, limitations and/or exclusions may affect coverage. You can ask the patient to advise us by calling our Customer Service department, or you can send a copy of the notice from the patients former carrier that includes this information. See Related Links below for information about each specific fee schedule. Mailing addresses for your AARP Dental Insurance Plan claims. Sacramento, CA 95853-7007 Dental Office Supplies & Essentials |
Delta Dental will process the primary benefits, even if processing the secondary coverage must be delayed (for lack of eligibility data, for example). Savings plans are NOT insurance and the savings will vary by provider, plan and You'll be receiving an email with the information you've requested shortly. Please input information for either ZIP code or address but not both, Please enable your browser to allow this site to use your location. Daniel Ribeiro , Dentist has not uploaded any photos. These listings are updated on a regular basis, and every effort has been made to ensure that only participating active providers are listed. Do you submit claims attachments electronically? Smiles for Children (SFC) is Virginia's Medicaid and FAMIS dental program for adults and children. The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. Dental Handpieces & Dental Handpiece Repair |
Example:If you replace a crown that is less than five years old, anticipate the obvious question and explain what event or circumstance made the replacement necessary. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. That was pretty easy. Its just not a payable claim under the terms of the dental benefit contract. Dental consultants cannot directly observe a patients condition, so let them know what cannot be seen on an x-ray and any special circumstances unique to your claim. In this case, the secondary carrier would pay $14 ($80 x 80% - $50 = $14). Oral Cancer Screening Light Tool | Identafi |
Anticipate what questions a dental consultant may have regarding a particular claim and provide the reason it should be paid. Your actual cost may be higher or lower than the estimate for various reasons. Refer to your benefit plan to determine whether preventive services are covered for you. Dual coverage information, including the amount payable by the prime carrier. First, log in to Provider Tools. Find the one thats right for you. We offer vision coverage through DeltaVision in 15 states and the District of Columbia.