What is Delta Dental?
Delta Dental is a nonprofit, group dental benefit administrator. For more than 60 years, Delta Dental has helped remove financial barriers to oral health services for more Americans than any other dental benefits carrier. We educate and empower people to take responsibility for their oral health. Delta Dental provides dental benefits for one of every four Americans with dental coverage.
What is Delta Dental EPOTM?
Delta Dental EPO (Exclusive Provider Organization) is a fee-for-service program. Payment for treatment is based on a fee schedule and member copayments. Delta Dental EPO participating dentists are reimbursed on the basis of the member copayment amount and the lesser of the submitted fee or Delta Dental’s maximum fee allowance, as payment in full when treating eligible Delta Dental EPO patients. Total payment will not exceed Delta Dental’s maximum approved fee allowance.
What are the advantages of participating in Delta Dental EPO?
Participating dentists are listed in our closed-panel directory, and members are required to receive services from Delta Dental EPO dentists. Delta Dental remits benefit payments directly to participating dentists. Participating dentists collect only copayments from Delta Dental EPO members. As with other Delta Dental programs, you and your staff will have access to the Dental Office Toolkit® and DASI (Delta Dental's IVR phone system) 24/7.
How do I know if a patient is eligible for Delta Dental EPO benefits?
You can verify eligibility and access benefits and claims information through the Dental Office Toolkit. We recommend that you verify patient eligibility prior to rendering treatment. You also can access our DASI system 24/7 at 800-870-9988.
Are claims filed for Delta Dental EPO patients?
Yes. To make things easier for you, Delta Dental offers several convenient solutions. To submit claims electronically at no charge, use the Dental Office Toolkit. Alternatively, you may use a clearinghouse that will usually charge a per claim or monthly fee, or you may mail paper claims to:
PO Box 9085
Farmington Hills, MI 48333-9085
What if a patient has a condition that may require treatment by a specialist?
The patient can be referred to a Delta Dental EPO participating specialist. To get a list of participating Delta Dental EPO specialists in your patients’ area, call DASI at 800-870-9988, or use the Delta Dental EPO dentist directory on our websites.
If I sign an agreement, how long do I have to remain participating? Am I free to terminate the agreement at any time?
The agreement remains in effect until either party terminates it. We require participating dentists to provide a 30-day written notice before resigning from the Delta Dental EPO program.
If I have questions about participation with Delta Dental EPO, whom do I call?
Our professional relations representatives are available to give you all of the information about participating with each Delta Dental program, facilitate the contracting process, and assist staff with Delta Dental claims administration. To schedule a personal visit to your office or request more information, call customer service at 800-524-0149 or use our online request form.