delta dental fee schedules by zip code
You should always talk to your health care professionals for information concerning diagnosis and treatment, including information regarding which drugs or treatment may be appropriate for you. The SFC program is managed by Dentaquest. Unfortunately, we cannot provide pre-treatment estimates by telephone. Waiving copayments violates the contracted dentists participation agreement with Delta Dental as well as the patients dental benefits contract. Customers can upgrade any fee analysis to a complete Henry Schein Practice Analysis for an additional $99 per zip code. Dental Infection Control Supplies & Products | Generally, claims received more than 12 months after the date of treatment may not be paid. Prior approval is not required when you refer a patient to a specialist. The description of different treatment categories, and the inclusion of particular services in a treatmentcategory,is not advice that any particular treatment category is the right treatment for you or that you should not obtain any particular treatment. Delta Dental reviews allowances on an ongoing basis. U. S. Mail:Delta Dental of Pennsylvania,ATTN: Provider Onboarding, P.O. P.O. Do you use the Internet to obtain eligibility and benefits information or check on the status of claims? Type in the zip code of your choice and balance your fees right from the start! Your National Provider Identifier (NPI) is an important number for all providers to have in order to successfully submit claims with Delta Dental. They will update your records with Delta Dental in other states. When Delta Dental is secondary in dual coverage cases, please include the primary coverages total liability including copayment/coinsurance percentage and the explanation of benefits (EOB). Be sure to enter the treating dentists license number or National Provider Identifier (NPI). Dental Finishing Supplies | who participate in MetLife's Preferred Dentist Program will charge, but may vary Want to know before you set foot in the dentists office? Fees with decimal points (for example, 100.00; not 100). Save time and money while helping the environment by electronically submitting your encounter forms to DeltaCare USA. Dentists are encouraged to seek their own legal advice about how the NPI pertains to their practices and circumstances. The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what dental benefits your plan will cover, or your out-of-pocket costs. Mailing addresses for your AARP Dental Insurance Plan claims. All of those matters are things that you should decide, in consultation with your dental care professionals. AED Units and Defibrillator Products | Members have a fixed copayment for all covered services and cannot be balance billed. All Rights Reserved. For example, allowances for Delta Dental PPO are different in most cases from those for the Delta Dental Premierplan. Please do not submit original radiographic images if they are the only diagnostic record for your patient. If the claim does not have this field, please list each item on a separate line. Preventive care coverage varies by plan and by demographic considerations such as age. Six-digit dates with no spaces, slashes or dashes (for example, 120320 for December 3, 2020). DELTA DENTAL PATIENT DIRECT GENERAL DENTIST FEE SCHEDULE ALL PROCEDURES Effective from 06/01/2022 D2712 Crown - Resin-Based Composite (Indirect) $305 D2720 Crown - Resin With High Noble Metal $648 D2721 Crown - Resin With Predominantly Base Metal $561 D2722 Crown - Resin With Noble Metal $625 D2740 Crown - Porcelain/Ceramic $725 When Delta Dental of California is the secondary carrier and is subject to the provisions of the California Health and Safety Code 1374.19, we pay the lesser of: (1) the amount we would have paid in the absence of any other dental benefit coverage; or (2) the member's out-of-pocket cost payable under the primary plan for benefits that are covered by the secondary plan. A spouse or domestic partners plan is secondary. If you are unsure of your dentists zip code, you may enter your home zip code. For more details see our privacy policy. Do you submit claims attachments electronically? Read our Fact Sheet to learn more: Smiles for Children Member Brochure (Spanish), Smiles for Children Adult Dental Benefit FAQs, Adult Dental Services for Virginia Medicaid Members - Webinar, Adult Dental Services for Virginia Medicaid Members - Slide Deck Announcing Benefit, Adult Dental Services for Virginia Medicaid Members - Slide Deck Announcing Benefit (Spanish). AARP Dental Insurance Plan c/o Delta Dental Insurance Company The benefit is based on theapproved fee for conventional orthodontics. Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates, Submitting claims for dependents age 19 and over, Electronic encounter forms for DeltaCare USA. No. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at 1-888-632-5353 with the ADA Code of the procedure and we can provide the discounted fee. All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI. You may be responsible for the cost of procedures or services not covered by your plan. Periapical radiographs - pre- and post-operative. This cost estimator is intended for use in the 50 states, Puerto Rico and other U.S. territories. Dental Supplies & Specialty Products | Sacramento, CA 95853-7007 Vinyl Polysiloxane (VPS) Dental Impression Material | Minneapolis, MN 55440-9304 . The Henry Schein Fee Analysis can help you determine proper UCR fees for a given area well in advance of your grand opening. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Looking to cover yourself or your family? You no longer need to send us paper claims just because you need to send an attachment. For full time students, enter the name of the school and the city in which it is located on the claim. Tubing Suction Connect | 23219For Medicaid EnrollmentWeb: www.coverva.orgTel: 1-833-5CALLVATDD: 1-888-221-1590. Consult with your provider prior to beginning any treatment. Find out more about how this website uses cookies to enhance your browsing experience. Document exceptional or unusual circumstances only in the Remarks or Comments field of the claim. To begin using the Dental Care Cost Estimator tool, click the Agree button below. Dental consultants are licensed dentists, who share your depth of knowledge about dental treatment and disease. How maximum contract allowances are determined, How maximum contract allowances are updated. Dental Curing Lights - LED Curing Lights | Box 997330,Sacramento, CA 95899-7330. Patients may change their coverage, usually in the fall or spring, during their open enrollment periods. Periodontics (including scaling and root planing), Description of service: KY Medicaid Dental Fee Schedule 2022 Revised 3/17/2022 Proc Code Procedure Description UNDER AGE 21 Rate 21 and OVER Rate Notes D2161 AMALGAM-FOUR/MORE SURFACES, PRIMARY OR PERMANENT $93.60 $72.00 D2330 RESIN-ONE SURFACE, ANTERIOR $57.20 $44.00 D2331 RESIN-TWO SURFACES, ANTERIOR $71.50 $55.00 D2332 RESIN-THREE SURFACES, ANTERIOR $85.80 $66.00 Be sure to submit dual coverage information on claims for orthodontic procedures, even if the other insurance does not cover orthodontics. Dental Digital Radiography & Digital X-Ray Equipment | Pre-treatment estimates are especially beneficial when expensive or extensive treatment is being considered and/or dental plan annual maximum, limitations and/or exclusions may affect coverage. However, some health plans may choose to require NPIs on all transactions. For further assistance, please contact E-Commerce Technical Support at 1-800-711-6032, Monday through Friday between 8:00am-8:00 pm ET. Delta Dental. Complete the claim information, select Continue, then Submit Claim. Did you know that dental benefit contracts are initially determined by your UCR fee schedule? Listerine Ultra Clean Floss | Estimates should not be construed as financial or medical advice. For assistance call 1-800-372-4346, 8:00am-8:00pm ET. (This might require you to upgrade your software. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. We do not return radiographic images or other documentation submitted with paper claims; however, we will make an exception when we receive a stamped, self-addressed envelope with the claim. For DeltaCare USA, maximum contract allowances are not applicable. The Henry Schein Fee Analysis provides dentists and dental professionals with the latest UCR (Usual, Customary, and Reasonable) fees for the zip code of your choice. Do not submit documentation with other procedures (unless Delta Dental specifically requests it). Check out Virtual Consult, Check out our new DeltaVision plans Preventive Products: GC MI Paste Plus, Colgate PreviDent, PreviDent | Mailed applications may require up to 20 days to process. No data found. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. Ditto marks or arrows to indicate duplicate information. Download Supporting Materials (Free for ADA members) 2022 Survey of Dental Fees Use of this website in no way increases or decreases the benefits available under a dental benefit plan. App features may vary by geographic area and individual dentist participation. Daniel Ribeiro , Dentist has not yet specified details about his experience and accolades. contain certain exclusions and limitations. D6055-D6077, D6082-D6088, D6094, D6097-D6099, D6110-D6123, D6194-D6195, Description of service: *Not sure where your company is headquartered? Dental Cements - Temporary & Permanent - Dental Liners | If the fathers birth date is 10/3/67 and the mothers birth date is 5/15/68, then the mothers coverage is primary. PO Box 1809 Next, in the Type of Transaction menu, choose Pre-Treatment Estimate. Is there a charge to join any of your networks? Smiles For Children (SFC) pregnant individuals enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older 600 East Broad StreetRichmondVirginia. Delta Dental has the largest network of dentists nationwide. Connect with your Delta Dental to learn more. Dental Adhesives: Dental Cements & Dental Liners | Everything you need to know about submitting Delta Dental claims. Oral health habits Dental Reminder Postcards and Filing Office Supplies | %%EOF Select the patient, then select the Submit Claim icon in the Actions menu. During clinical review of claims and pre-treatment estimates, Delta Dental reserves the right to request radiographic images and/or documentation for procedures that otherwise may be identied as not requiring the submission of documentation. This website is the home of Delta Dental of California; Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; Delta Dental of West Virginia, Inc. and their affiliated companies. Dental coverage is now available for adults! In this case, generally, the plan through current employment is primary. ZIPCODE TO CARRIER LOCALITY FILE (see files below) your dental service provider's fees and is for informational purposes only. Every 12 months you may submit separate Delta Dental Premierfee updates for each practice location, specialty and TIN. We strongly recommend that you confirm that a provider is currently participating before you receive any services from that provider. A medical plan may be primary when an accident has caused the need for dental treatment (such as a broken tooth resulting from a fall or a car accident). Maximize your oral health and make the most of your dental benefits right from your mobile device by downloading the Delta Dental Mobile App. members under age 21 are covered for all medically necessary dental services pregnant individuals enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older DMAS - Department of Medical Assistance Services, Breast & Cervical Cancer Prevention and Treatment Act, Addiction and Recovery Treatment Services, Hospital Presumptive Eligibility Information, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Behavioral Health Service Utilization and Expenditures, Legislative and Congressional District Reports, Monthly Expenditure Reports of the Medicaid Program, Nursing Facility Value-Based Purchasing Program, CHIP State Plan and Waiver-Related Documents, Learn more about how you can use Smiles for Children insurance, | | s -w-po-ny | | | Deutsch | | Tagalog | Franais | | Igbo asusu | | | Espaol | | Ting Vit | Yorb. 2018 MetLife Services and Solutions, LLC. Include the amount paid by the previous carrier on the claim. Allowances will differ depending on the type of plan. Mechanicsburg, PA 17055-2059. Contact DentaQuest at 1-888-912-3456 or search the DentaQuest website to find a listing of dentists who accept Medicaid in your zip code. See Related Links below for information about each specific fee schedule. "Delta Dental" refers to the national network of 39 independent Delta Dental companies that provide dental insurance. Delta Dental Premierand Delta Dental PPO Claims. If you answer yes to any one of the following questions, you are considered a covered entity under the NPI standard and are required by federal law to obtain an NPI. Lysol IC Spray | Like most dental benefit plans, MetLife's dental plans Everything you need to know about claims and payments. Box 2105 Every month, millions of patients use these tools to find, evaluate, and engage with the providers best suited to address their specific needs and preferences. By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. Or, you may mail a paper claim to Delta Dental. Department of Medical Assistance Services. Box 1810 Chart notes should always include diagnosis and justification for all treatment rendered. 1The [Price Without Plan] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. An NPI is required by the federal Health Insurance Portability and Accountability Act (HIPAA) for electronic transactions. Otherwise, the natural parent the child lives with provides primary coverage. The information and content (collectively, "Content") on this website is for your general educational information only. Refer to your benefit plan to determine whether these requirements apply to you. Using correction fluid or a highlighter pen. 4. Sharps Disposal Containers - Small & Large Sizes | its provided. Two jobs or two retiree plans: The plan that has covered the employee longest is primary. Articulating Paper for Occlusal Contacts & Forces | Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. Please re-enter. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The patient is responsible for their coinsurance/copayment portion only. Dental Practice Marketing & Office Supplies | there is no paperwork or reimbursement, you must pay for the service at the time You will receive the discount off the providers usual and customary 2 Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. Here are the benefits of creating an account. For more detailed information on your dental care costs, please consult your dentist or your Delta Dental. In the following states, you can change your dentist any time without contacting Delta Dental: AK, CT, LA, ME, MS, MT, NC, ND, NH, OK, SD, VT, WY. If you live outside the U.S., you may see information on this cost estimator about products or services that are not available or authorized in your country. Delta Dental Insurance Company How much is it going to cost? Dental Unit | Extraction - Impacted Wisdom Tooth (Soft Tissue), Extraction - Impacted Wisdom Tooth (Partial Bony), Add Clasp to Existing Bridge (Partial Denture), Tooth Replacement Part of Permanent Bridge, 25739 Branch Rail Dr Ste 160 Chantilly, VA 20152, 7764 Armistead Rd Ste 100 Lorton, VA 22079, Nevermind, take me back to DentalPlans.com, Full Orthodontic Child Treatment (Braces), Full Orthodontic Adult Treatment (Braces), Surgical placement of implant body: endosteal implant, Abutment supported cast metal crown (predominantly base metal). Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. Please register your NPI with Delta Dental by providing us with a copy of the confirmation containing your NPI that you receive from the National Plan & Provider Enumeration System (NPPES). Simply submitting it on a claim will not ensure that it's entered into the Delta Dental system. Delta Dental recommends that all dentists obtain and use a National Provider Identifier (NPI). Therefore, it is always best to confirm information with yourhealth careprofessionals. Your actual cost may be higher or lower than the estimate for various reasons. Some procedures are not covered under your patient's plan, no matter what documentation is submitted. DeltaCare USA There is no need to resubmit the claim. This brochure describes the benefits of Delta Dental's Federal Employees Dental Program under Delta Dental of California contract OPM02-FEDVIP-02AP-05 with OPM, as authorized by the FEDVIP law. hbbd```b``z"g E,r D2`i`v X.X1X$ LNH`Xed_@d:H=D bg`ig ^ U. S. Mail:Delta Dental Insurance Company,ATTN: Provider Onboarding, P.O. Be sure to include the following information on dual coverage claims: For adults, the member's plan through his or her employment is primary. Orthodontics Supplies & Tools | On claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. Retired or planning to soon? Dental Continuing Education Seminars & Resources | Understand the difference between what is covered and what is needed. 1The [Price Without Plan] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Pediatric Dental Supplies & Instruments | Oral Surgery Instruments, Anesthetic & Supplies | dental entity's Type 2 NPI (if different) to npi@delta.org Please also include the dentist's name, practice name, address and license number. If the patient is a dependent with a disability, enter the nature of the disability. The NPI replaces other identifying numbers used in electronic transactions, such as: The NPI willnotreplace these numbers, which are used for purposes other than general identification: NPIs are issued by the National Plan & Provider Enumeration System (NPPES). Watch the video below for an overview of the new dental health coverage for adults. DentalPlans.com makes it easy for dentists who accept Dental Savings Plans from one or more of our network partners to confirm patients plan membership. Delaware, District of Columbia, Maryland, New York, Pennsylvania and West Virginia: E-mail:ddpdentist_services@deltadentalpa.org The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. Log in here This will lead you to the claim adjustment form, where you can indicate the issue(s) that needs to be addressed with your claim, provide necessary details and upload supporting documentation. Dental Products - Professional Services | Is keeping employees healthy and productive one of your priorities? To expedite the processing of your claim, utilize the requirements below to identify the necessary documentation and/or clinical information required for review of specific procedure codes. All Rights Reserved. The Content on this website is not medical advice. First, log in to Provider Tools. Dental Diagnostic Equipment | based on the circumstance and specialty of the Provider. Call and make sure that your provider accepts Medicaid coverage so you can receive quality services at no cost. No dentist found that matches your criteria, I receive dental insurance through my employer, Please enter a treatment type and/or valid 5-digit ZIP code. %PDF-1.6 % View plans, sample savings & pricing, patient reviews & practice information. the START SEARCH button thats all you need! All claims submitted are subject to MetLife's Simply submit a separate Confidential Fee Filing Form for each update. When a patient has coverage through TRDP and another dental plan, the plan that has covered the member the longest is considered primary. Please Note: The information displayed below is not a guarantee of coverage, and Refer to your benefit plan to determine whether these requirements apply to you. Estimated fees for Zip Code The procedures discounted under these plans and programs offer similar savings to the sample above. Example:If you replace a crown that is less than five years old, anticipate the obvious question and explain what event or circumstance made the replacement necessary. Delta Dental PPOSM, PF, 1500A, 100*/90/50, 50 Calendar year costs Deductible $50 per person / $150 family Out-of-pocket maximum (under age 19) $375 for one member / $750 for two or more members (in-network only) Annual maximum (age 19+) $1,500 Class 1 does not apply to max Minimum number of subscribers N/A Class 1 Already registered with :DP Verify? 0 Alpharetta, GA 30023-1809. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at 1-888-632-5353 with the ADA Code of the procedure and we can provide the discounted fee. Your actual cost may be higher or lower than the estimate for various reasons. to claim your profile. Box 2059 You can ask the patient to advise us by calling our Customer Service department, or you can send a copy of the notice from the patients former carrier that includes this information. Virtual Consult To find Enter the required documentation information in the Remarks or Comments field of the claim. Contact your company's human resources department. This is important because some services may be included in the patients basic coverage, even if the patient does not have specific orthodontic coverage. The procedure fee displayed can differ if your dental service providers office is We often hear Henry Schein customers state that they arent concerned with balancing UCR fees because they participate with various dental benefit providers. Consult with your provider prior to beginning any treatment. By submitting your information, you are agreeing to receive communications from DentalPlans.com. Sitemap - Henry Schein Dental. Oral surgery (impacted tooth), Description of service: The NPI Enumerator will help you with your NPI application and to update your information in the NPPES. D4210-D4212, D4240-D4245, D4260-D4285, D4341-D4342, D4381, Description of service: Your Tax Identification Number (TIN, EIN or SSN). Health information changes quickly. Dental Tools & Instruments - Hand & Surgical Instruments | Cost estimates for services provided by out-of-network dentists (available in the out-of-network estimator) are based upon submitted claims data for out-of-network providers. If a court order makes one parent more financially responsible, that parent provides primary coverage. DentalPlans detailed profile of Roshanak Rastegar , DDS - Dentist in 20152. The sample table above is a small selection of common procedures discounted by these discount dental plans and programs. MEMBER FEE SCHEDULE MEMBER PAYS DENTAL SERVICE (Maximum Charge) Delta Dental of Illinois DDIL.PD.FS.0802 Diagnostic Services D 0120 Periodic oral evaluation $23 D 0140 Limited oral evaluation-problem focused $34 . We have dental insurance that empowers you to protect the oral health of you and your loved ones. Verify that the dentist is your selected DeltaCare USA primary care dentist before each appointment. This means Delta Dental has overpaid weve paid 100% of $80 instead of 80% of $80. U. S. Mail: Delta Dental of California,ATTN: Provider Onboarding,P.O. Chart notes including periodontal case type and diagnosis. Box 2106, Mechanicsburg, PA 17055. Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. Daniel Ribeiro , Dentist has not yet specified details about his education and training. First, select the patient. Delta Dental and its affiliate companies use MetaVance Benefit Administration Software as the claims editing software product to provide timely and efficient adjudication for dental claims. Once you're a member, you will be provided with a complete fee schedule (applicable for most plans) with discounted fees for nearly every dental procedure. How much is it going to cost? Boston, MA 02129. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. Delta Dental recommends that the NPI be used on all claims. ), you are responsible for submitting an update to the NPPES within 30 days of the change. Example:If your fee for a service is $100 and you wish to give the patient a 20% discount, then $80 becomes the fee that is actually charged and $80 should be entered on the claim as the total fee. The information provided here is for educational purposes only and should not be interpreted as legal advice. Enter a corporate or residential street address, city, and state to see a specific ZIP Code . 118 0 obj <> endobj Savings plans are NOT insurance and the savings will vary by provider, plan and Copyright 2023 Henry Schein, Inc. All rights reserved. Have a question about coverage or looking for dental insurance? Use your FastAttach connection, a service available through NEA, to electronically transmit digitizedx-rays, narratives, intra-oral pictures, Explanation of Benefits (EOB) Statements or any other document needed to adjudicate the claim.
