Dentist Participation and Reimbursement
Dentist participation with MIChild
Delta Dental Premier participating dentists in Michigan are automatically eligible to treat children enrolled in MIChild and Healthy Kids Dental (HKD). Delta Dental Premier dentists may elect to opt out of only the MIChild and HKD programs and continue to participate with all other Delta Dental Premier groups. To opt out, mail or fax a statement to Delta Dental declaring nonparticipation with only these two programs. Include the doctor’s name, tax identification number, license number, and office address. Nonparticipating status for MIChild and HKD will be effective 30 days from the date Delta Dental receives the statement. Address your request to Provider Records, Delta Dental, PO Box 30416, Lansing, MI 48909-7916, or fax to (517) 706-3618.
Reimbursement for services rendered to MIChild enrollees
Reimbursement to all Michigan participating dentists for covered services rendered to MIChild enrollees is based on the Delta Dental PPO fee schedule. Eligible MIChild enrollees can receive treatment from any Delta Dental Premier participating Michigan dentist who agrees to accept the lesser of the submitted fee or the amount in the MIChild fee schedule as full payment for services. The dentist cannot balance bill the enrollee for any difference between his or her regular fees and the amount in the current fee schedule. This schedule is, on average, 66–89 percent higher than traditional Medicaid reimbursement.
All covered services for eligible MIChild enrollees are reimbursed at 100 percent of the dentist’s submitted fee or the amount in the MIChild fee schedule, whichever is less. Aside from a few exceptions noted in the fee schedule, all of Delta Dental’s standard time limitations and policies apply to the covered services.
For any services not covered by MIChild or that exceed the $600 annual maximum, the cost will be the responsibility of the enrollee or responsible party. Delta Dental recommends that the dental office discusses these costs with the MIChild enrollee’s responsible party prior to rendering treatment.
Verification of eligibility before each appointment is essential.
NOTE: Delta Dental will not prohibit a MIChild provider from advocating on behalf of the enrollee in any grievance or utilization review process, or in the predetermination process to obtain a benefits estimate.