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. Use Provider Tools forfreereal-time claims with digital attachments and pre-treatment estimates. Like most dental benefit plans, MetLife's dental plans 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). Locate your processed claims by entering your claim number and selecting "Search.". dental entity's Type 2 NPI (if different) to npi@delta.org Please also include the dentist's name, practice name, address and license number. Privacy Statement Terms of Use Social Media Policy. The patient should refer to his/her to beginning treatment. Pre-treatment estimates often process within moments (when clinical review isnt required), so you can talk with your patients about treatment plans while they are still in your office. 1The [Price Without Plan] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Review Sample Pricing with a Savings Plan Below. Delta Dental of California and Affiliates is a part of Delta Dental Plans Association. My Contracted Fees 1. 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 NPI Enumerator will help you with your NPI application and to update your information in the NPPES. However, we strongly encourage you to get one, because you can use it as a single unique identifier with all payers. Always notify Delta Dental of the actual fee charged. Be sure to regularly review and update your patients dual coverage status. Repair requiring lab work, Procedure codes: Log in here Duplicate radiographs or radiographic image copies of diagnostic quality, including paper copies of digitized images, are acceptable. This cost estimator is intended for use in the 50 states, Puerto Rico and other U.S. territories. To be sure, please refer to your dentist handbook. AED Units and Defibrillator Products | Need to make an adjustment on a claim? A pretreatment %PDF-1.6 % If you . Resources. Dental Lab Coats | DentalPlans.com makes it easy for dentists who accept Dental Savings Plans from one or more of our network partners to confirm patients plan membership. How maximum contract allowances are determined, How maximum contract allowances are updated. 465 Medford Street, Ste 400. Do you use the Internet to obtain eligibility and benefits information or check on the status of claims? D4210-D4212, D4240-D4245, D4260-D4285, D4341-D4342, D4381, Description of service: We update them regularly, usually every 6 to 24 months. For DeltaCare USA, maximum contract allowances are not applicable. 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. Claims will be processed when received according to your plan provisions. 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. Delta Dental Insurance Company By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. This is a10-digit random number unique to each health care provider or organization. The combined payments by all plans may not exceed the total fee for the treatment. For a complete description of the details of your coverage, please refer to your coverage documents. Periapical radiographs pre- and post-operative, Chart notes including periodontal case type and diagnosis, Narrative including necessity of treatment and mobility of teeth, Periapical or bitewing radiographs documenting bone loss, Narrative including necessity of treatment, Periapical or panoramic radiographs - current, Narrative including diagnosis, orthodontia type, and treatment length, Narrative for any exceptional cases and/or unspecified codes in all categories of service (D##99). Chart notes should always include diagnosis and justification for all treatment rendered. We have coverage options designed to fit your business. P.O. U. S. Mail:Delta Dental Insurance Company,ATTN: Provider Onboarding, P.O. Customers can upgrade any fee analysis to a complete Henry Schein Practice Analysis for an additional $99 per zip code. Our procedure fee tool provides participants of dental plans insured or administered Balance your fees before negotiating your PPO reimbursement contracts. We often hear Henry Schein customers state that they arent concerned with balancing UCR fees because they participate with various dental benefit providers. To make it easier for you, your fees for these visits are included in the total fee you submit on the claim for banding and in the periodic payments you automatically receive from Delta Dental. Once you submit your claim adjustment request, it can take up to 21 calendar days for it to process. Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates, Submitting claims for dependents age 19 and over, Electronic encounter forms for DeltaCare USA. Everything you need to know about submitting Delta Dental claims. Log in here Estimates may vary depending on your benefit plan and the state you live in. 2Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. Dental Infection Control Supplies & Products | Enter a ZIP Code to see the cities it covers. Writing on top of lines or outside of boxes. Box 2106, Mechanicsburg, PA 17055. Extraction - Impacted Wisdom Tooth (Soft Tissue), Extraction - Impacted Wisdom Tooth (Partial Bony), Add Clasp to Existing Bridge (Partial Denture), Tooth Replacement Part of Permanent Bridge, 25739 Branch Rail Dr Ste 160 Chantilly, VA 20152, 7764 Armistead Rd Ste 100 Lorton, VA 22079, Nevermind, take me back to DentalPlans.com, Full Orthodontic Child Treatment (Braces), Full Orthodontic Adult Treatment (Braces), Surgical placement of implant body: endosteal implant, Abutment supported cast metal crown (predominantly base metal). The procedures discounted under these plans and programs offer similar savings to the sample above. Please Note: The information displayed below is not a guarantee of coverage, and Delta Dental PPOSM, PF, 1500A, 100*/90/50, 50 Calendar year costs Deductible $50 per person / $150 family Out-of-pocket maximum (under age 19) $375 for one member / $750 for two or more members (in-network only) Annual maximum (age 19+) $1,500 Class 1 does not apply to max Minimum number of subscribers N/A Class 1 Or, you may mail a paper claim to Delta Dental. The Find the one thats right for you. 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. 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. By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. Faxes are not accepted. In this case, the secondary carrier would pay $14 ($80 x 80% - $50 = $14). Your actual cost may be higher or lower than the estimate for various reasons. hbbd```b``z"g E,r D2`i`v X.X1X$ LNH`Xed_@d:H=D bg`ig ^ Dental Financing and Related Services | For more detailed information on your dental care costs, please consult your dentist or your Delta Dental. Copy of lab bill. If you do not agree with Delta Dentals determination of benefits, and you have additional information to provide, you may request reevaluation by submitting: Mail this information to theDelta Dental member companythat originally processed the claim or pre-treatment estimate. In joint custody cases, the parent Dental coverage is now available for adults! Email: CustomerCare.Credentialing@greatdentalplans.com. than what is displayed. Notes: View plans, sample savings & pricing, patient reviews & practice information. Delta Dental has the largest network of dentists nationwide. Simply submit a separate Confidential Fee Filing Form for each update. Disposable Dental Supplies - Single Use Products | Special promotions including, but not limited to, additional months free are not available If the claim does not have this field, please list each item on a separate line. Appliance name used to control harmful habit. Is keeping employees healthy and productive one of your priorities? For assistance call 1-800-372-4346, 8:00am-8:00pm ET. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. the START SEARCH button thats all you need! Minneapolis, MN 55440-9304 . Then, select the Submit Claim icon under Actions. A medical plan may be primary when an accident has caused the need for dental treatment (such as a broken tooth resulting from a fall or a car accident). During clinical review of claims and pre-treatment estimates, Delta Dental reserves the right to request radiographic images and/or documentation for procedures that otherwise may be identied as not requiring the submission of documentation. You should always talk to your health care professionals for information concerning diagnosis and treatment, including information regarding which drugs or treatment may be appropriate for you. Preventive care coverage varies by plan and by demographic considerations such as age. Mailing addresses for your Delta Dental Premier and Delta Dental PPO claims. 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. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. 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. Have a question about coverage or looking for dental insurance? Please make sure we have your correct Tax Identification Number (TIN) on file to facilitate correct payment. For more details see our privacy policy. Consult with your provider prior to beginning any treatment. Charges for clear aligners (e.g., Invisalign, SureSmile) should be submitted using theappropriate orthodontic procedure code (D8010-D8090). Example:If you submit a claim for a crown that was placed to restore a tooth with a fractured cusp, be sure the fractured cusp is visible in the x-ray copy. Click the ">" to move your selection to the box on the right side. This is important because some services may be included in the patients basic coverage, even if the patient does not have specific orthodontic coverage. Anticipate what questions a dental consultant may have regarding a particular claim and provide the reason it should be paid. Do not avoid getting dental care based on the cost information provided on this website. The data is based on actual, non-discounted charges that providers have billed. Photocopied claims that are blurred or skewed. A spouse or domestic partners plan is secondary. out additional fee information on common procedures in your area, the process is 2 Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. U. S. Mail:Delta Dental of Pennsylvania,ATTN: Provider Onboarding, P.O. to claim your profile. Daniel Ribeiro , Dentist has not uploaded any photos. 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. based on the circumstance and specialty of the Provider. Indicate a quantity (the number of x-rays, for example) in the field on the claim specifically for this purpose. Delta Dental will process the primary benefits, even if processing the secondary coverage must be delayed (for lack of eligibility data, for example). Oral surgery (surgical incision/excision), Description of service: Box 6059 Therefore, it is always best to confirm information with yourhealth careprofessionals. The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. Generally, claims received more than 12 months after the date of treatment may not be paid. Member perks for your smile and beyond All CDT codes not listed are discounted 20% off the usual fee. there is no paperwork or reimbursement, you must pay for the service at the time Prosthodontic Instruments & Supplies | Delta Dental Patient Direct coverage is not available in all 50 states. Dental Unit | The data is based on actual, non-discounted charges that providers have billed. Look at you smiling. Cosmetic Dentistry: Teeth Whitening & Alignment | hb```g``Zpj1 X{ y `` estimate is recommended before the start of extensive dental treatment. Find out more about how this website uses cookies to enhance your browsing experience. Your actual cost may be higher or lower than the estimate for various reasons. 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). No data found. Estimated fees for Zip Code At Henry Schein, you can Rely on Us for all of your dental practice needs. Eliminates the need to maintain and match identification numbers to specific payers for transactions, Allows you to relocate your practice or change specialties without requiring new identifiers from multiple payers, Helps reduce costs and simplify health care transactions, Contributes to more efficient coordination of benefits. 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. D7410D7415, D7440D7461, D7465, Description of service: Youll see Delta Dentals payment and the patient portion when the claim or pre-treatment estimate processes, often within moments (when clinical review is not necessary). Any additional fee for the nontraditionalmethod is not billable to the patient. More Information On Dental Supplies | Listerine Ultra Clean Floss | . After you register, claim your free Doctor.com profile to expand your reach online. 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. Medicaid members can now access more dental services. PO Box 1809 Do not submit documentation with other procedures (unless Delta Dental specifically requests it). Compare your fees to the 40th - 95th . Saving money by eliminating printing, copying and mailing costs. Since endstream endobj startxref The Content cannot, and is not intended to, replace the relationship that you have with yourhealth careprofessionals. 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). Dental Sleep Medicine - Sleep Apnea Prevention | Ditto marks or arrows to indicate duplicate information. When this occurs, please submit only one claim to the Delta Dental company. Be sure to include the following information on dual coverage claims: For adults, the member's plan through his or her employment is primary. Dental Office Supplies & Essentials | Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. * All pre-treatment radiographs, photographs and charting should be within 12 months of the planned treatment unless otherwise specified. Copayment waivers are a form of overbilling the dental carrier. Want to know before you set foot in the dentists office? Daniel Ribeiro , Dentist has not yet indicated the hospitals that he is affiliated with. E-mail:customerservice@npienumerator.com, Telephone:800-465-3203 / 800-692-2326 (NPI TTY), Mail:NPI Enumerator Dental & Porcelain Veneers: Dental Laminates | Dental Digital Radiography & Digital X-Ray Equipment | However, we do suggest that you refer your patients to a Delta Dental Premier participating specialist to minimize your patients' out-of-pocket costs. Connect with your Delta Dental to learn more.