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HKD Dentist Participation and Reimbursement

Dentist participation with Healthy Kids Dental

Delta Dental Premier participating dentists in Michigan are automatically eligible to treat children enrolled in Healthy Kids Dental (HKD) and MIChild. Delta Dental Premier dentists may elect to opt out of only the HKD and MIChild 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 HKD and MIChild 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 HKD enrollees

Reimbursement to all Michigan participating dentists for covered services rendered to HKD enrollees is based on the Delta Dental PPO fee schedule. Eligible HKD 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 HKD 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 HKD enrollees are reimbursed at 100 percent of the dentist’s submitted fee or the amount in the HKD 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. Additionally, because HKD is a public program designed to deliver medically necessary treatment, the removal of asymptomatic third molars is not a covered benefit.

For any services not covered by HKD, the cost will be the responsibility of the enrollee or responsible party. However, such cost must be discussed with these individuals in advance, and non-covered (or alternate) services should only be done with their agreement to pay for those services.

IMPORTANT: Please check the eligibility of every HKD patient on the day of treatment.

NOTE: Delta Dental will not prohibit a Healthy Kids Dental 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.

HKD Information for Dentists:

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