Dear providers:
We’ve reimagined our occasional newsletter to make it a monthly must-read full of policy updates and practical tips. Check out this month’s communication designed to help you stay informed, save time and focus on patient care.
Code D2940
Effective June 1, Delta Dental of Ohio requires the inclusion of the applicable tooth number and surface(s) for Code D2940 when submitting claims. This update aligns with the expectations of the ADA. If both the tooth number and surface(s) are not submitted for Code D2940, the claim will be denied.
For more information, please refer to Appendix 3: ADA Guide to Dental Procedures Reported with Area of the Oral Cavity or Tooth Anatomy (or Both).
Electronic IR
Submit and respond electronically
As of May 31, providers with an active Dental Office Toolkit™ (DOT) account are only able to submit and respond to Information Requests electronically through DOT. All other DOT functionality remains the same.
Need assistance?
If you need assistance with DOT, please call Toolkit Support at 866-356-0301.
Have questions?
If you have other questions, please contact your professional services representative.
Appointment timeliness reminders
Delta Dental PPO™ and Delta Dental Premier®
The Centers for Medicare and Medicaid Services has a provider wait time standard to ensure that new or existing patients who obtained dental coverage through the federal exchange can obtain a dental appointment with any in-network Delta Dental PPO™ or Delta Dental Premier® dentist (including specialists) within 30 business days of the patient requesting an appointment from the office.
Ohio Medicaid and Next Generation MyCare
Required by the Ohio Department of Medicaid, patients in these networks must be seen or scheduled within a set time frame based on treatment urgency. Find these benchmarks in your participation contract or below for general practitioners or pediatric dentists:
• Urgent care— 24 hours, 7 days/week within 48 hours of request
• Emergency services—provider must be available immediately, 24/7
• Non-emergent/non-urgent services including routine and preventative care—schedule within six weeks of request
If you need help meeting these standards, please call your professional services representative.
Next issue of Best Practice Magazine
The next issue of Best Practice Magazine will be published this summer. The theme, “Access into Action,” will showcase stories about how access to resources leads to real use and benefits for members and providers.