Providers:
Check out our monthly must-read designed to help you stay informed, save time and focus on patient care.
Reminder: Urgent prior authorization requests
To ensure timely and appropriate review of prior authorization and other review requests, requests submitted as urgent or expedited must meet the CMS definition of an expedited request and be supported by clinical documentation demonstrating the urgent need.
CMS defines an expedited/urgent request as:
“A request for a determination in which waiting for a decision under the standard timeframe could place the member's life, health, or ability to regain maximum function in serious jeopardy.”
Providers are encouraged to carefully assess the clinical circumstances and submit all relevant supporting documentation at the initial submission to avoid delays in processing.
Reminder: Dental home assignments
We’re proud to be the sole carrier for Healthy Kids Dental (HKD) members starting Oct. 1, 2026. To provide access to all members, current and new HKD members will be assigned to a primary dental provider—called a “dental home.” The dental home model helps members know where to get care by connecting them with a high-quality dentist who provides ongoing, preventive care and coordinates specialist referrals when needed.
Note:
- Members retain flexibility to visit any participating dentist. They are not restricted to their dental home and are able to choose a different provider if they wish.
- Members not assigned to your office may also still be seen and will be reimbursed as usual.
For questions, please contact your professional services representative.
New adult Medicaid network going live Jan. 1, 2027
Our new Healthy Adult Dental (HAD) network will go live Jan. 1, 2027.
HAD will replace our Michigan TriState Advantage network, becoming the sole network for adult Medicaid, Healthy Michigan Plan and MI Coordinated Health (MICH) members. This change is to strategically support anticipated membership growth and improve overall network efficiency.
Please watch your Inbox for a provider contract Amendment via a DocuSign link for convenient completion. Please complete this by Nov. 6 to avoid claim delays. Alternatively, the Amendment can be downloaded online and emailed to gpproviderrequests@mydeltadental.com or faxed to 517-381-5649.
