Delta Dental’s Healthy Michigan Plan network serves both Medicaid and Healthy Michigan Plan members with dental coverage through Health Alliance Plan (HAP CareSource), McLaren, Meridian Health Plan, Priority Health or Upper Peninsula Health Plan (UPHP).
Medicaid and Healthy Michigan Plan (HMP) provider copay obligations
The Centers for Medicare and Medicaid Services require that all providers treating Medicaid and Healthy Michigan Plan members discuss copays with members at the time of service. Not all health plans require a copay for dental visits, so members should visit HealthyMichiganPlan.org to learn more about how copays apply to them.
If a procedure does not appear on your fee schedule, it is not a covered benefit. Payment for noncovered services is the responsibility of the member or responsible party; however, the fee must be discussed with the individual in advance and treatment should only be rendered if they agree to pay for noncovered (or alternate) procedures. The member’s or responsible party’s approval to proceed with treatment, knowing they will be financially responsible, should be noted in the patient record. If a member or responsible party agrees to pay for a noncovered service, the Healthy Michigan Plan participating dentist will be held to the lesser of the submitted fee or the Delta Dental PPO™ fee schedule for any charges to the member or responsible party. Due to federal Medicaid requirements, covered services that are denied by Delta Dental (for example, a procedure that exceeds a frequency limitation) cannot be charged to the member or responsible party unless the member or responsible party has agreed to pay for it.
IMPORTANT ELIGIBILITY INFORMATION
Verification of eligibility on the date of service of each Medicaid and Healthy Michigan Plan patient is essential as eligibility for patients may change frequently. If a Medicaid or Healthy Michigan Plan provider’s office fails to check eligibility on the date of service for a Medicaid or Healthy Michigan Plan patient and delivers services to an ineligible patient, the provider will not receive reimbursement from Delta Dental and cannot bill the patient for the services.
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Healthy Michigan Plan network requirements
It’s important to remember the appointment access standards for your patients.
These standards are as follows:
Dental plan appointment and timely access to care standards
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| Type of care |
Length of time |
| Emergency dental services |
Immediately, 24/7 |
| Urgent care |
Within 48 hours |
| Routine care |
Within 21 business days of request |
| Preventive services |
Within six weeks of request |
| Initial appointment |
Within eight weeks of request |
Claims address
Delta Dental
PO Box 9298
Farmington Hills, MI 48333-9298
Healthy Michigan Plan network dental manual
Log in to Dental Office Toolkit® to download and view the Healthy Michigan Plan Network Dental manual.
Within this manual you can review policies and procedures, provider (and patient) rights and responsibilities, including the provider appeal and dispute process.