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Frequently Asked Questions
Does Delta Dental offer individual insurance?
Delta Dental does not offer individual insurance. Delta offers group insurance, through an employer, to companies with 10 or more employees.
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What is the difference between the Delta Dental Premier and the
Delta Dental PPO programs?
Delta Dental Premier, the largest and most popular, is our
managed indemnity program.
Over 95% of the dentists in Missouri are on this unique panel.
The Delta Dental Premier program is not a discount program but
has set fees based on the current fees that dentists file with us. These
fees reflect local market fee structures.
Delta Dental PPO is our preferred provider service program, with a
reduced fee schedule. If you are not sure which Delta Dental program
you participate in, contact our Professional Relations Department at (314) 656-3000
or (800) 392-1167 in Missouri or (803) 731-2495 or (800) 529-3268 in South Carolina.
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What is Claimsnet and how can I learn more
about it?
Delta Dental has established a partnership with
a company called Claimsnet to provide a more streamlined and inexpensive
alternative for claims submission.
Claimsnet.com is a leading
provider of Internet-based, business-to-business solutions for the
healthcare industry, including distinctive, advanced ASP technology for
online claims processing. This proprietary system is easy to use, secure
and inexpensive. Here's how it works?
- Claims are sent directly from your office to
Claimsnet.
- Claimsnet will review your claims before they
are submitted to make sure that payer-specific requirements are met.
- As a result of these checks over 98% of claims
submitted are accepted the first time ? saving labor ? and speeding the
time to reimbursement.
- Dentists pay a flat monthly fee of $25,
regardless of volume, for claims or attachments submitted to Delta.
- If you submit an average of 100 or more
claims monthly, Claimsnet will save you money.
And there are other
benefits. . .
- This web-based service requires no new hardware or
software to initiate.
- Works with most practice management software.
- Offers secure claims submission any time -
day or night.
Installation of Claimsnet is very
easy. When you select Claimsnet, you will
discover a simpler, faster, more economical way to submit claims. For more information,
log on to the
Claimsnet site.
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What is FastAttach™ and how can I learn more about it?
FastAttach? enables dental offices
to transmit dental attachments (x-rays, perio charts, intra-oral pictures,
narratives and EOBs), via the Internet, to the National Electronics
Attachment, Inc. (NEA) repository.
Delta Dental of Missouri then views them
as part of the electronic claim
adjudication process. For dental offices, FastAttach? accelerates claim processing
and eliminates the need and cost to duplicate and mail
x-rays and other necessary attachments.
NEA is offering Missouri and South Carolina Delta Dental participating providers a special 50% discount
off the $200 registration
fee for FastAttach?. When registering, use the promotion code "DDMO." Registration includes
software, installation and training. The FastAttach? service plan has a monthly fee that includes
unlimited usage (no per attachment fee), unlimited telephone support, and software upgrades at no
additional charge. The FastAttach Plus service plan also has a monthly fee and includes the same
services as FastAttach with the addition of unlimited storage and transmission to peers. There
are no hidden costs. To learn more about NEA?s Dental Services, click on
www.welcometonea.com. From there, you can go
directly to an online registration, or you can view Frequently Asked Questions, a current Payor List,
and scanner recommendations.
Are predeterminations required?
No they are not required but suggested. A predetermination will let you know what out-of-pocket expenses you will have before the dentist's services are rendered.
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When I send a claim to Delta Dental, should I also send an x-ray?
Not every procedure requires an x-ray for professional review. Procedures
which routinely require pre-operative radiographs of the treatment area
are single crowns, inlays, onlays and veneers. We require full arch
radiographs for all initial bridges. We do not require x-rays for
initial endodontic therapy.
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Where can I get contact information for the other Delta Dental plans?
Delta Dental contact information may be useful to you when submitting DeltaUSA claims. To see a list of all of the Delta Dentals, click here.
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Does my office participate in the Delta Dental PPO plan?
If you don't know, you should have one of our customer service representatives
check for you. This information is very
important because it determines how your patient's benefits are paid. When a patient
asks if you participate with Delta Dental, please be specific about which Delta Dental
network you participate in. This will help your patient understand correctly the benefits
he or she will be entitled to with his or her company's dental plan. Benefits vary depending
upon the treatment of an "in" or "out" of network dentist, so it's important for the patient
to know in which network you participate. So when your patient asks, "Do you accept Delta Dental?" please
respond by correctly informing them of your network participation.
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What is the correct mailing address for Delta Dental?
All paper claims should be mailed to P.O. Box 8690, St. Louis, MO
63126-0690.
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When are checks mailed out?
Checks are mailed from Delta Dental's office weekly on Thursday.
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How do I send claims electronically?
Your Practice Management vendor or representative will provide you with all the necessary instructions and paperwork for submitting claims electronically via your office PC.
If you do not have a practice management software system, but do have a PC, you can contact WebMDEnvoy at their toll-free number 1-877-GO-WEBMD and speak to one of their technical support staff to see if your PC is capable of submitting claims electronically.
Delta Dental of Missouri does not require any special enrollment for electronic submission. All services, with the exception of orthodontic procedures, may be submitted electronically.
Who Is Involved in Electronic Claims Submission?
The Dentist:
The Dental Office submits claims electronically via their office PC to a clearinghouse.
The Practice Management Vendor:
The practice management vendor is responsible for your PC software. This vendor also provides daily technical support and troubleshooting assistance.
The Clearinghouse:
The clearinghouse is responsible for the transmission of the claims to Delta Dental of Missouri and other insurance carriers who accept claims electronically. At the clearinghouse, all claims are reviewed for completion to ensure they are ready to send to each carrier. They also provide several reports that include important information for tracking claims and requests for additional information from the insurance carrier. The reports vary depending on your practice management system and your vendor will provide a copy of the standard clearinghouse reports.
Delta Dental of Missouri:
We are available to discuss any questions you may have regarding your electronic claims submissions. Please call us at 1-800-392-1167 or e-mail us at Support@ddpmo.org.
Electronic Submission Tips
When selecting a clearinghouse vendor make sure that the submitted dental practice name, address, TIN number and names of practicing dentists are the same as what you have on file with Delta Dental of Missouri.
If you add or remove a dentist from your practice, you will need to notify both the clearinghouse and Delta Dental of Missouri.
Verify that the Payor ID number is accurate. Delta Dental of Missouri's Payor ID number is 43090.
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