For all providers
News and information for all participating commercial, Medicaid and Medicare providers
Dental Office Toolkit™ (DOT) enhancements
We care about your time. Providers can now manage claims more efficiently with enhanced search and filtering tools, sortable columns, expanded treatment details and CSV export capabilities. These improvements make it easier to find, review and track claims, helping reduce administrative burden and streamline day-to-day claims management.
Cracking the code: D4249 (crown lengthening) vs. D4212 (gingivectomy for restorative purposes)
Definitions
According to the American Dental Association’s Code on Dental Procedures and Nomenclature, clinical crown lengthening involves hard tissue (bone) removal in addition to soft tissue removal. This involves a periodontal flap and alteration of the crown to root ratio.
D4249
When doing a crown lengthening, the appropriate code is D4249. Documentation for D4249 should clearly support the restorative need for crown lengthening, the flap and the removal of supporting bone.
Quick tip:
If no bone is removed, D4212 is generally the appropriate code. If bone removal is required to expose additional tooth structure for restoration, use D4249.
First accredited dental therapy program
In 2028, Ferris State University will offer an accredited dental therapy program—the first of its kind in Michigan. Although Michigan currently has two practicing dental therapists, both had to pursue their education out of state, with funding from the Delta Dental Foundation, Michigan Health Endowment Fund and the Michigan Primary Care Association.
Ferris State’s first dental therapy class will accept 12 students, and the program will be open to students from a variety of educational backgrounds. Read more about Ferris State University’s dental therapy program: “Ferris taps public health dentist to launch Michigan’s first dental therapy program.”
For Medicaid and Medicare providers only
News and information for all participating Medicaid and Medicare providers
Reminder: Urgent prior authorization requests
To ensure timely and appropriate review of prior authorization and other reviews, 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.
Healthy Kids Dental (HKD) Quality Assessment and Performance Improvement Plan
Delta Dental of Michigan conducts a review of its HKD Quality Assessment and Performance Improvement Plan annually. For more information and the results of the annual review, please email deltadentalnewsletter@deltadentalmi.com to receive a copy.
Medicare Advantage requirement: Type 2 (organization/business) National Provider Identifier
Providers submitting claims for Medicare Advantage members must have a Type 2 National Provider Identifier (NPI) on file for their business. Federal law requires all healthcare providers and organizations use a standard identifier in their administrative and financial transactions.
All electronic claims submitted to Delta Dental must include:
- Treating dentist’s Type 1 NPI
- Treating dentist’s state license number
- Tax Identification Number (TIN) of the billing dentist or practice
- Type 2 NPI to identify the billing provider, following these guidelines:
- Multiple dentists at one practice location (group practice, partnership): Type 1 for each dentist and Type 2 for the practice, if claims are transmitted in the practice’s name and TIN.
- Multiple dentists at multiple practices (clinics, dental service organizations, etc.): Type 1 for each dentist and Type 2 for each practice, with a separate TIN.
To register for a Type 2 Billing NPI, please go to the NPI registry. For step-by-step registration instructions, please refer to our guide. Delta Dental does not have access to your application status.
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