Suspension of paper claims processing
Delta Dental of Michigan, Ohio, and Indiana previously advised you that paper claim processing would experience significant delays due to procedures enacted to protect our employees. As of April 7, 2020, a decision was made to suspend processing of all paper claims, as we felt it was necessary to protect the health and safety of our employees. Electronic claims will continue to be processed as usual.
Paper claims are processed in our Oakland County, Michigan office. Oakland County, together with surrounding counties of Wayne and Macomb, have been identified as COVID-19 hot spots. We did not want to place our employees at a heightened risk and opted to close the facility until the Oakland County area experiences a decline in cases. While we recognize the impact to our providers, a cost-free alternative to submitting paper claims is available to you.
We encourage you to submit claims through the Dental Office Toolkit® (DOT). If you do not already have a DOT account, you can create your free account here. DOT is an online portal that provides you with 24/7 access to instant claims processing, patient eligibility and benefit information and much more. You can also enroll in EFT payments—view the tutorial here.
If you have to send a paper claim or correspondence, use the following tips to expedite processing once it resumes:
- Don’t use staples or tape. Fold claims and attachments together, or use paper clips.
- Only send attachments if required. We do not require supporting X-rays, chart notes, periodontal charting or narratives for most services. If we need supporting documentation to reach a determination, we will reach out to you through an information request.
- If Delta Dental is secondary, it is not required or necessary to include a copy of the primary carrier’s Explanation of Benefits. Simply notate the primary carrier payment amount in the remarks section of the claim.
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Policy for provider calls to customer service
As the COVID-19 pandemic spread nationwide, the Delta Dental of Michigan, Ohio, and Indiana customer service team began answering member phone calls exclusively and asked that providers use the Dental Office Toolkit® (DOT).
On April 27, 2020, we began accepting calls from providers who need assistance only with claims questions, problems and adjustments.
If you have questions about eligibility or benefits, or you need copies of EOBs or pre-treatment estimates, you should continue to use DOT. Customer service representatives will not provide this information over the phone for any plan except Medicare Advantage and Medicaid plans. General information will still be accessible through DASI.
This is a long-term policy change. With fewer eligibility and benefit calls, our representatives can focus more on complex issues for both providers and members.
This change empowers you to access information exactly when you need it. No more time spent on the phone or waiting in a call queue. Plus, DOT’s new features give you easy access to:
- Check patient eligibility and review patient benefits.
- Submit claims and pre-treatment estimates in less than 60 seconds.
- Post payments and update EFT information.
- Search comprehensive family claims history across all businesses.
- Manage user roles and permissions for your office staff.
What if I don’t have computer access? General eligibility or benefit information will still be available through DASI. However, any additional information must be accessed through DOT. Customer service will only assist with claims questions, problems or adjustments.
How do I register for a DOT account? Visit www.dentalofficetoolkit.com to register your office. Training videos, how-to guides and other resources are available to help set your office up for success.
I need help registering my office for DOT or have questions. Who can I call? Our Toolkit support team is available to get you started and answer any questions you have. Call them at 866-356-0301.
What if I can’t find the answer I need on DOT? Benefit or eligibility information for nonroutine codes not found in DOT can be obtained by submitting a pre-treatment estimate.
How do I obtain a copy of an EOB or pre-treatment estimate? Copies of EOBs or pre-treatment estimates can be found in DOT, or can be obtained by fax when using DASI. A customer service representative is unable to provide copies of these documents to you.
Does your patient have Delta Dental coverage through a Medicare Advantage or Medicaid plan? Be sure to call the appropriate number to reach the correct service center.
- Michigan, Ohio or Indiana Medicare Advantage: 800-330-2732
- Healthy Michigan Plan and Pregnant Women Dental: 866-558-0280
- Healthy Kids Dental: 866-696-7441
- MI Health Link: 800-838-8957
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Delta Dental now paying code D2941
Delta Dental prioritizes the health and safety of our providers and members as we navigate through the COVID-19 pandemic.
We have made an interim policy change regarding code D2941 due to findings by the World Health Organization and the Centers for Disease Control and Prevention (CDC) that show primary transmission of the coronavirus through upper respiratory tract droplets.
The American Dental Association and the CDC recommend avoiding aerosols when possible, like those generated from high-speed rotary instruments commonly used to prepare teeth for permanent restorations.
To support this precaution, Delta Dental of Michigan, Ohio, and Indiana is now paying D2941—Interim therapeutic restoration: primary dentition—Placement of an adhesive restorative material following caries debridement by hand or other method for the management of early childhood caries.
Before this interim change, D2941 would not have been billable if a permanent restoration is completed within 24 months.
Once the COVID-19 pandemic subsides, a definitive restoration can then be placed without financial penalty to the dentist or patient.
For permanent teeth, continue to use code D2940—Sedative fillings, temporary restorations used to relieve pain during an interim period—with the same rationale for treatment.
Update on teledentistry benefit
If you are looking for ways to help your patients while your office is closed due to COVID-19, teledentistry may be an option.
Also, know that the Office of Civil Rights (OCR) at the Department of Health and Human Services (HHS) says it “will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”
Unless there is a specific exclusion, Delta Dental of Michigan, Ohio, and Indiana plans will benefit D0140 (problem focused examination) in accordance with the terms of the applicable group’s contract whether provided in a dental office or virtually, effective from March 20, 2020, until the public health situation is resolved.
The service will be paid providing the patient has coverage/benefits available.
We will continue to evaluate these interim policies as necessary. Thank you for the care you provide to our members, especially during these most challenging times.
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Funding assistance opportunities
As you navigate your dental practice through this pandemic, recognize that there are multiple opportunities for financial assistance.
- The Small Business Association has a Paycheck Protection Program that can help pay payroll and business-related utilities, rent or mortgage interest for the eight-week period following receipt of the loan, and is eligible for loan forgiveness. Dykema, a national law firm, held a webinar on this topic April 6 and has linked to a helpful presentation and voice recording. Click here to review the resources.
- The Small Business Association has told the American Dental Association (ADA) that dentists can apply for BOTH Economic Disaster Loans and Paycheck Protection Program loans. Learn more from the April 6 issue of ADA News.
- Watch the ADA’s webinar, Small Business Administration Loans: Understanding the Options for Dentist Owners. Click here.
- Check out the ADA’s website, www.ada.org/virusresources, that offers practice management resources including a Q&A document about the Small Business Interruption Loans under the federal CARES Act and information about the ADA Foundation Charitable Assistance Fund grant program. The ADA also offers webinars about topics including the CARES Act, infection control and business impact of the pandemic. Scroll to the bottom of this site for information.
- For resources and information for your practice including details on the Michigan Small Business Relief Program, visit michiganbusiness.org/covid19 or call the Michigan Economic Development Corporation at 888-522-0103.
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Required info for claims submissions
To ensure smooth claims processing, it’s imperative that your records with Delta Dental be kept up-to-date. This includes your TIN, and Type 1 and Type 2 NPIs, as applicable.
- For Medicare Advantage and Medicaid, all claims submitted by group practices must include a billing Type 2 and the Type 1 NPI of the rendering provider to be processed.
- Sole proprietors should submit their Type 1 NPI in the billing field to be processed. If you are a sole proprietor with a Type 2, you should submit your Type 1 in the rendering field and the Type 2 in the billing field.
- If the TIN on a submitted claim does not match our records, the claim will be denied.
- Claims should always be submitted with the service office information where services were rendered. Do not submit the payment office address.
If you have concerns, or need to change or verify your records, email firstname.lastname@example.org.
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If you look around in a time of crisis, you’ll always find the helpers. Those who step forward, who go above and beyond, who persist when the storm gets rough. Dentists are natural helpers, so it’s no surprise that we’ve heard of amazing ways our Delta Dental providers are helping their communities.
Keep reading for three spotlights. If you are volunteering in your community – whether by sharing your medical expertise, donating PPE or more, we want to give you a shout-out! Reach out to Lisa Nguyen, special projects and public relations officer, at email@example.com.
Dr. Amy Gentner, Gentner Family Dentistry
St. Johns, Michigan
“It is a war out there and it is not going to be won by just a couple of people.”
When Dr. Amy Gentner and her associate Dr. Kayla Weatherwax realized there was a need in their community for personal protection equipment (PPE) amid the coronavirus crisis, her small town roots kicked into full gear.
Gentner is the owner of Gentner Family Dentistry which has been in St. Johns, Michigan, for 15 years—a trusted small business in the farming community.
Despite the coronavirus shutting down just about everything in town, she and Weatherwax are seeing some patients on an emergency basis, but still leaving them with an overflow of supplies and PPE.
Answering the call from local health care institutions, Gentner went through her supply cabinet and found hundreds of masks, surgical gowns and 25 pair of scrubs that were going unused and donated them to Ouch Urgent Care in St. Johns. Masks and cleaning supplies were also donated to Clinton Area Ambulance Services for paramedic use.
“We’re small town dentists supporting our small town hospital and urgent cares,” Gentner said. “Everyone that I’ve talked to is trying to help in different ways.”
Dr. Stephen Harris, Stephen R. Harris, DDC PC
Farmington Hills, Michigan
Dr. Stephen Harris has practiced dentistry for 36 years and has felt the direct impact of statewide COVID-19 closures.
“This COVID-19 crisis has basically put us out of business, shut us down,” he said.
Initially, he did his due diligence to disinfect and remove commonly touched objects like magazines and children’s toys in his office to minimize the spread of COVID-19, but it soon became a reality that a full shutdown was on his doorstep. This forced Harris’ staff to join the thousands of Michigan citizens filing for unemployment.
Although Harris now faced challenging times with the new normal and threat of COVID-19 exposure, he chose to take action when he heard about widespread shortages of personal protective equipment.
“Thankfully, Sherry, my assistant, does a nice job keeping the office supplied. We had wipes, hand sanitizers and gloves in large containers,” said Harris.
He donated his supplies to the nearest donation center in Oakland County, which turned out to be a simple process.
“The people out there that are the frontline of any kind of crisis—all first responders – your heart goes out to them. In this situation, all those people you see on TV that are doing swabs in the car lines and in the hospital running around… (they’re) trying to be protected themselves so they don’t end up being victims or patients. They need all the help they can get. God bless them. I felt morally it was common sense, and I had a desire to help others. It’s the least I can do.”
He continues to regularly check in with his staff to make sure they are managing the crisis as best as they can, but Harris also has a daughter who was drafted into a pool of essential workers at Munson Hospital.
“It’s all-hands-on-deck working 60 hours a week. This crisis will affect her. Anything we can do to help is worth it. All we’re asked to do is to sit home and watch TV. They’re out there dealing with the sick people in this crisis.”
Dr. Tim Zielinski, Zielinski Dental,
Dr. Tim Zielinski is a busy man. And now he’s busier than ever.
With his dental practice in Mason, Michigan, closed due to COVID-19, he’s seen a surge in patients at Care Free Medical in Lansing where he volunteers his talents.
Care Free Medical is a safety-net clinic providing medical, dental, optometry and behavioral health care to people with limited access to the health care system.
His staff is stepping up, too, and helping him at Care Free as much as they’re able. Because emergency rooms are so overrun with high-need patients dealing with complications due to COVID-19, more and more patients without insurance are going to safety-net clinics like Care Free to relieve their dental pain.
“It’s a mission for me to go in there and help these people. They can’t go to the ERs right now,” Zielinski said.
He has been seeing up to 30 people a day at Care Free, about 10 more patients a day than he normally would.
“It’s a tear-jerking thing to see these people, but we get them in and take care of them. It’s like a Monopoly game. We have to get the puzzle right.”
Over the past few weeks he said he’s witnessed hugs, kisses, tears and joy from patients who are grateful for the care they’ve received.
“They are just so relieved to get that infection or tooth out that they’ve waited months and months for.”
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New online CE courses
If you’re pursuing continuing education (CE) courses during our state stay home orders, remember that Delta Dental provides online CE courses at no cost to our participating providers—dentists, hygienists, assistants and office staff. This month, we have two new courses available. Sign up, log in and view these learning programs today.
Sign up and log in here: https://www.deltadentalmi.com/onlineeducation. Courses include:
- New: The Proper Handling of Amalgam and its Wastes—Complying with the New EPA Rules
- New: Safe Opioid Prescribing Practices, New Laws and Regulations
- Dental Care for Children with Special Health Care Needs
- How to Complete an Age 1 Dental Visit
- HPV and Head and Neck Cancer
- Human Trafficking—Modern Day Slavery
- Infant and Toddler Oral Health Care
- Periodontal and Peri-Implant Diseases and Conditions
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CHAMPS enrollment required for your practice
As part of Affordable Care Act requirements, providers and businesses who accept Healthy Kids Dental, Healthy Michigan Plan or MI Health Link patients must enroll in the Michigan Community Health Automated Medicaid Processing System (CHAMPS).
We understand that many providers have already registered themselves. However, businesses who submit claims to Delta Dental for these programs must also enroll in CHAMPS as soon as possible.
The Michigan Department of Health and Human Services (MDHHS) will not allow Delta Dental to make payment on claims for Healthy Kids Dental, Healthy Michigan Plan or MI Health Link patients if the business where services were rendered is not enrolled in CHAMPS.
How to enroll your business in CHAMPS
1) Before enrolling in CHAMPS, you must enroll in the State of Michigan’s SIGMA Vendor Self Service to obtain a Vendor Customer ID number.
Click to follow step-by-step instructions for SIGMA enrollment. A new user vendor guide is also available here. Following your SIGMA enrollment, you will receive a new Vendor Customer ID. This will be required to complete your CHAMPS business enrollment.
2) After you have completed SIGMA enrollment and received your new vendor customer ID, you can complete your business CHAMPS enrollment.
Click here to visit the Group section of the MDHHS Health Care Providers page. There you will find the CHAMPS Enrollment Application: Group User Guide, which provides links and enrollment instructions. Additional resources and guides are also available on this site.
Need additional assistance? Call the CHAMPS help desk at 800-292-2550.
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PPE assistance request
Given the critical need in Michigan hospitals for personal protection equipment (PPE), if it is possible for your practice to review its inventory and identify items to donate locally, please consider doing so.
Equipment can be shipped or dropped off at the closest Regional Emergency Management Coalition site.
Delta Dental of Michigan is making this request in conjunction with the recommendations by the Michigan Health and Hospital Association and the Michigan Dental Association.
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