Our Networks

• A preferred provider organization program and a fee-for-service program.
• No balance-billing on covered services.
• Dentists file claims for members.
• Popular with employers, so dentists who participate in this network may see an increase in patients.
• Prior approval is not required to refer a patient to a specialist.

• Combines the characteristics of Delta Dental Premier and Delta Dental PPO into one flexible program.
• Members who do not go to a participating Delta Dental PPO dentist can still receive treatment from a Delta Dental Premier dentist, but often at a higher out-of-pocket cost.

• Offered through health plan partners with dental benefits administered by Delta Dental.
• Members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits.
• No balance-billing on covered services.

• A fee-for-service program.
• No balance-billing above the approved Delta Dental Premier fee (reviewed annually).
• Members are responsible for their copayment and deductible (if any).
• Dentists file claims for members.
• Prior approval is not required to refer a patient to a specialist.
• Participating Michigan dentists are automatically eligible to treat children enrolled in Healthy Kids Dental.

• Combines the characteristics of Delta Dental Premier and Delta Dental PPO into one flexible program.
• Members who do not go to a participating Delta Dental PPO dentist can still receive treatment from a Delta Dental Premier dentist, but often at a higher out-of-pocket cost.

• Offered through health plan partners with dental benefits administered by Delta Dental.
• Members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits.
• No balance-billing on covered services.

• An exclusive provider organization (EPO) and fee-for-service program.
• Members must receive care from participating Delta Dental EPO dentists.
• Dentists file claims and receive payments directly from Delta Dental; collect only copayments (if any) from members
• Participation includes Medicare Advantage plans administered by Delta Dental that use the EPO network.

• Offered through health plan partners with dental benefits administered by Delta Dental.
• Members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits.
• No balance-billing on covered services.

Serves traditional adult Medicaid and Healthy Michigan Plan members.

• A program offered through the Michigan Department of Health and Human Services and administered through health plans.
• Provides medical coverage, including dental benefits, to low-income Michigan residents age 19 to 64 who are in the income segment just above traditional Medicaid.
• Reimbursement to participating dentists is based on the Delta Dental PPO fee schedule.
• All covered services will be reimbursed at 100 percent of the dentist’s submitted fee or the amount listed in the fee schedule.
• No balance-billing on covered services.
• Members can receive treatment from any Healthy Michigan Plan participating dentist.
• If a procedure is not listed in the fee schedule of covered procedure codes, it is not a covered service.

Healthy Michigan Plan participating dentists are required by the Michigan Department of Health and Human Services to register their Type 1 NPI (individual) in the Community Health Automated Medicaid Processing System (CHAMPS). All incorporated businesses are also required to obtain a Type 2 NPI (business) and register it in CHAMPS.

Find instructions on NPI and CHAMPS enrollment.

• A dual Medicare and Medicaid program offered through health plans through the Michigan Department of Health and Human Services and in partnership with the Centers for Medicare and Medicaid Services.
• Reimbursement to participating dentists is based on the Delta Dental PPO fee schedule.
• No balance-billing on covered services.

Healthy Kids Dental (HKD) is a program offered through the Michigan Department of Health and Human Services and is administered in part by Delta Dental. It provides dental benefits to children who have Medicaid and are under the age of 21. To receive benefits, members must go to a Delta Dental HKD participating dentist, and the dentist cannot balance bill the member for the difference between the submitted charges and the approved fee schedule amount. Participating providers are required by the State of Michigan to register their Type 1 NPI (individual) in the Community Health Automated Medicaid Processing System (CHAMPS). All incorporated businesses are also required to obtain a Type 2 NPI (business) and register it in CHAMPS. 

Find instructions on NPI and CHAMPS enrollment.

This Delta Dental benefit reduces barriers to care by providing members with special healthcare needs enhanced benefits.

What’s included?

• Additional visits to the dentist’s office and/or consultations that can be helpful prior to the first treatment to help patients learn what to expect and what is needed for a successful dental appointment. Additional exam benefits will be allowed for this purpose.
• Up to four total dental cleanings in a year.
• Treatment delivery modifications, including anesthesia and nitrous oxide, necessary for dental staff to provide oral healthcare for patients with sensory sensitivities, behavioral changes, severe anxiety or other barriers to treatment.
   

Using the benefit

• Before rendering services, check the member’s procedure eligibility in the Dental Office Toolkit to verify coverage.
• If the member’s record has already been updated to allow services under this benefit, there will be a “Special Healthcare Needs Benefit” message.
• If there is not a message but the member says their plan includes this benefit and they have a qualifying special healthcare need, you should include code D9997 on the initial claim submission. After the first claim processes, the member’s record will update and you will not need to include the code for that member in the future.
• There is no age limit on these benefits. Note that the “Special Healthcare Needs Benefit” is different from the “Handicap” attribute.