As a reminder, Delta Dental requires that the treating dentist's (the dentist completing the service) license number and type 1 NPI (National Provider Identifier) is listed on all claim submissions. The treating dentist is responsible for ensuring the medical necessity and appropriateness of the services.
As the dental marketplace continues to change, hiring associates and having a multi-dentist practice is increasingly more common. Delta Dental receives frequent inquiries regarding the correct way to bill for services.
As such, it is important to notify Delta Dental when an associate, partner or temporary dentist is hired. We will update our claims processing system and associate the treating dentist to the billing entity or corporation so that claims are processed appropriately. There may be instances where the practice owner may be participating with Delta Dental but the associate is not participating. Since reimbursement rates differ for participating (in-network) providers versus nonparticipating (out-of-network) providers, this can cause confusion for both the practice-billing administrator and the patient. The claim can be processed and paid differently for nonparticipating providers, ultimately affecting the patient’s financial responsibility.
Recent versions of the American Dental Association (ADA) claim form provides clearly identifiable areas to report the billing entity and treating provider information. It is very important that dental offices report accurate treating provider information on the claim form. It is considered unprofessional conduct and fraudulent billing to do otherwise per the Michigan Public Health Code (Excerpt) Act 368 of 1978; Rule 333.16221(d)(iii).
We do not recommend to use older versions of the claim forms as they do not provide adequate areas of the reporting treating provider information. Using these older claim form versions does not dismiss an office requirement to report accurate treating provider information. New claim forms may be obtained through the ADA.
As a reminder, all participating dentists will receive quarterly (four times a year) mailings asking you to confirm dental office information or to make corrections or additions as needed. This helps us ensure our provider records are accurate. For faster service please contact provider records at 800-656-6495 for correct form(s) and any required documentation to add a provider to your location.
If your practice is changing email addresses, please let us know. Please send your name and new email address to firstname.lastname@example.org.