Welcome to the new Contract Corner! Each issue of News You Can Use will explore a different piece of your participation contract. This issue, we explore the difference between non-covered services and disallowed services.
Non-covered services
A non-covered service is a procedure that is simply not covered by a patient’s dental plan. Such services will be denied and, in accordance with the participation agreement, a dentist can only bill a patient up to a maximum allowable amount.
Services may not be covered because they are not covered in the patient’s benefit package, or because of contractual limitations, such as time limitations or annual maximum.
Per your participation agreement, participating dentists have to submit claims for all the procedures they perform, covered or non-covered.
Disallowed services
Disallowed procedures are a standard insurance industry practice and happen in less than 2 percent of Delta Dental claims. They are services that may be covered under a dental plan, but are not being paid for one of the following reasons:
A disallowed claim may be resubmitted with the requested information or appealed with new information.
If your practice is changing email addresses, please let us know. Please send your name and new email address to providerrequests@deltadentalmi.com.