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 members
Reimbursement to all Michigan participating dentists for covered services rendered to MIChild members is based on the Delta Dental PPOSM fee schedule. Eligible MIChild members 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 member for any difference between his or her regular fees and the amount in the current fee schedule. This schedule is, on average, 66 to 89 percent higher than traditional Medicaid reimbursement.
All covered services for eligible MIChild members 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.
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 an HKD/MIChild member or responsible party agrees to pay for a noncovered service, the HKD/MIChild 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 (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.
Once accepted, the child is enrolled in MIChild for one year (unless the State is notified that the family no longer is eligible). After one year, the family must reapply.
IMPORTANT ELIGIBILITY INFORMATION
Verification of eligibility on the date of service of each Healthy Kid's Dental and MIChild (HKD/MIChild) patient is essential as eligibility for HKD/MIChild patients may change frequently. If a HKD/MIChild provider’s office fails to check eligibility on the date of service for a HKD/MIChild 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.
NOTE: Delta Dental will not prohibit a MIChild provider from advocating on behalf of the member in any grievance or utilization review process, or in the pre-treatment estimate process to obtain a benefits estimate.