5.9 million lives covered by Delta Dental of Michigan
Thank you for your continued dedication to our members!
Changes coming to Medicaid
As part of the Michigan Department of Health and Human Services Medicaid redesign, several changes will take effect April 1 that impact providers serving Medicaid beneficiaries. Delta Dental will keep you informed of these changes—watch for updates via email, or visit our website at www.deltadentalmi.com for information.
Back to top
Customer service and operations corner
The operations team is a combination of data entry and mail services, totaling 40 employees. They process claims for Delta Dental Plan of Michigan, Delta Dental Plan of Ohio, and Delta Dental Plan of Indiana, plus Delta Dental companies in Arizona, Minnesota and North Carolina.
The best and fastest way to submit a claim or pre-treatment estimate is through the Dental Office Toolkit®(DOT).
- When you submit a claim through DOT, there is no mix-up on where the claim should go.
If you need to submit a paper claim, no worries! Our operations team is ready to handle each claim with care and efficiency. Here’s a look at our process:
- Our mail services team opens, sorts and scans all mail using an optical character reader (OCR) to convert the paper claims into an electronic data interchange (EDI) format so the claim can be processed.
- If there is something the OCR cannot convert properly, our capable data entry operators will key and process those claims manually, as well as returned updated information requests, Explanations of Benefits and pre-treatment estimates in for pay.
Some things to keep in mind for faster processing of paper claims submitted by USPS mail:
- Most plans have separate P.O. boxes for claims processing and written inquiries. Check the member’s plan for the correct PO box. This information can be found in DOT.
- Avoid using tape or staples.
- The ADA standard claim form is the best form to utilize.
- Rather than sending paper X-rays or hard copy radiographs, use electronic attachments, such as NEA.
- If you’re submitting claims for separate Delta Dental member companies, mail them in separate envelopes to ensure accurate processing.
Some fun facts when it comes to paper claims:
- On average, Delta Dental receives around 5,900 envelopes a day. This is tracked using our newly integrated mail tracker system.
- About 10 percent of the claims we process pass through our operations team as paper claims.
Back to top
Register for HIV Dental Symposium
Save your spot at the upcoming HIV Dental Symposium March 31 in Novi.
This daylong event from the Michigan Public Health Institute will update attendees on the care and delivery of oral health for people living with HIV/AIDS. Learn from HIV/AIDS experts about:
- Advances in medications
- Systemic effects of the virus
- Clinical dental treatment
- The dental team’s role in viral suppression
- Aging with HIV
The event will be held at Suburban Collection Showcase. See the full agenda and register here.
Back to top
Take online courses at no cost
Looking to add continuing education courses to your schedule? Check out Delta Dental’s CE course lineup!
- Delta Dental participating providers and their hygienists, assistants and office staff can take courses at no cost.
- Each course includes course content, an assessment and a certificate of completion.
- Earn .5 to 1 CE credit per course.
Consider these course offerings:
- How to Complete an Age 1 Dental Visit
- Infant and Toddler Oral Health Care
- Dental Care for Children With Special Health Care Needs
- The Seal is the Deal
- Fluoride
- Nutrition for Oral and Overall Health
- Nutrition for Health and Disease Prevention
- HPV and Head and Neck Cancer
- Human Trafficking—Modern Day Slavery
- Opioids, the Opioid Epidemic and Opioid Use Disorder
- Periodontal and Peri-Implant Diseases and Conditions
- Safe Opioid Prescribing Practices, New Laws and Regulations
- The Proper Handling of Amalgam and its Wastes—Complying With the New EPA Rules
Visit www.deltadentalmi.com/onlineeducation to learn more.
Delta Dental Plan of Michigan Inc. is an ADA CERP-recognized provider.
Back to top
New benefit for HKD
If you have patients with Healthy Kids Dental benefits, take note of a new covered benefit.
Effective January 1, 2023, in addition to first and second permanent molars, dental sealant coverage for eligible enrollees under the age of 21 includes fully erupted first and second primary molars, and first and second permanent premolars.
- Sealants are covered once every three years and reimbursement includes the repair and replacement of the sealant over this period. The tooth surface(s) involved must be free of caries and of any other restorations for coverage.
Find important benefit information and more on Dental Office Toolkit®.
Back to top
Using provider pay form
If a Delta Dental Medicare Advantage or Medicaid member requires services not covered in their benefit plan, be sure to obtain a signed private pay form from that member or member’s guardian before rendering services.
These members may be part of Healthy Michigan Plan, Healthy Kids Dental, Medicare Advantage, Pregnant Women Dental program or MI Health Link program. If a procedure is not listed in Delta Dental’s fee schedule for the above programs, or if it exceeds an age or frequency limitation, it is not a covered benefit under that program and is considered a non-covered service.
Payment for non-covered services is the responsibility of the member or the responsible party. Before providing non-covered services, the cost of the non-covered service(s) must be discussed with the member or responsible party. Treatment can only be provided if and when the member or member’s guardian signs a private pay form (to be signed on the day non-covered services are rendered), where they agree in writing to pay for the non-covered (or alternate) service(s).
You may use any form for the private pay form as long as it includes the cost associated with the non-covered service(s), the responsible party’s signature and the date. (See Delta Dental’s sample form here). Keep the signed form in your files as Delta Dental may request a copy.
The Delta Dental member’s or responsible party’s approval to proceed with non-covered services via the private pay form should be included in the patient’s record. If a member agrees to pay for a non-covered service, Delta Dental dentists will be held to the lesser of the submitted fee or the applicable Delta Dental fee schedule for any charges to the patient or responsible party.
Back to top
Fee increase
There was another fee increase January 1. Check the Dental Office Toolkit for an updated fee schedule.
Back to top