Our Networks

Delta Dental offers dentists the flexibility of participating with one or more of our networks, which serve a variety of commercial, Medicaid, Medicare Advantage, and Medicare and Medicaid dual program members.

Delta Dental offers dentists the flexibility of participating with one or more of our networks, which serve a variety of commercial, Medicaid, Medicare Advantage, and Medicare and Medicaid dual program members.

Delta Dental PPO™

Serves Delta Dental PPO (Standard), Delta Dental PPO (Point-of-Service) and Delta Dental Medicare Advantage™ members.

Delta Dental PPO (Standard)Delta Dental PPO (Point-of-Service)Medicare Advantage
  • 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.

Delta Dental Premier®

Serves Delta Dental Premier, Delta Dental PPO (Point-of-Service) and Delta Dental Medicare Advantage members.

Delta Dental PremierDelta Dental PPO (Point-of-Service)Medicare Advantage
  • 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.

Delta Dental EPO™

 

Delta Dental EPODelta Dental EPO CHAMPS-enrolled
  • 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.
  • EPO-participating dentists treating Meridian of Michigan, Inc., members 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.

Healthy Kids Dental Network

Delta Dental Premier® participating dentists in Michigan are automatically eligible to treat children enrolled in Healthy Kids Dental (HKD).

Learn more about the Healthy Kids Dental Network

Michigan TriState Advantage

Serves Healthy Michigan Plan and MI Coordinated Health members.

Healthy Michigan PlanMI Coordinated Health

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.
  • 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 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.

When you provide care to patients with Medicaid or Medicare benefits, you have the opportunity to address critical gaps in their oral health and make a positive impact on their overall health.

If you are scheduling patients who have Healthy Kids Dental, Healthy Michigan Plan, or Michigan Coordinated Health (MICH) benefits, remember that they must be seen or scheduled within a set time frame. These benchmarks are based on treatment urgency and are required by the Michigan Department of Health and Human Services. Find these benchmarks in your participation contract or below for general practitioners or pediatric dentists.

  • Urgent care—See within 48 hours
  • Routine services—Schedule within 21 business days
  • Preventive services—schedule within six weeks
  • Initial appointment—schedule within eight weeks
  • Emergency services—provider must be available immediately, 24/7

Other networks and programs

Including Healthy Kids Dental and Delta Dental's Special Healthcare Needs Benefit.

Healthy Kids DentalSpecial Healthcare Needs Benefit

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.
Dentist checking patient's teeth

Ready to join?

Our professional relations representatives are available to provide you with information about participating in each Delta Dental network, facilitate the contracting process and assist staff with Delta Dental claims administration.

Learn more

 

Evidence-based dentistry

Through our Research and Data Institute, we closely monitor and assess scientific findings to make evidence-based improvements to our plan designs. Many of these changes work to address patients with specific high-risk health conditions, where oral disease may put their systemic health at risk.

Other networks and programs

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.

High-risk medical conditions

Members with certain high-risk medical conditions can receive enhanced coverage. This includes those with diabetes and gum disease, pregnant women with gum disease, patients with kidney failure, those with compromised immune systems and patients with certain health conditions.

Early detection of oral cancer

This benefit covers a diagnostic test called the BrushTest (oral brush biopsy), which can detect oral cancer and abnormal cells that may become cancerous.

High-risk cardiac conditions

This benefit was developed to help at-risk individuals better maintain oral health to reduce bacteria levels in the mouth to lower their risk for infective endocarditis. This enhanced benefit includes coverage of up to four teeth cleanings per benefit year for those with heart conditions that place them at high or moderate risk for developing infective endocarditis.