FAQs About DeltaCare Participation
What is Delta Dental?
Delta Dental is a nonprofit, group dental benefit administrator. For more than 50 years, Delta Dental has helped remove financial barriers to oral health services for more Americans than any other dental benefits carrier. We educate and empower people to take responsibility for their oral health. Delta Dental provides dental benefits for one of every four Americans with dental coverage.
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What is DeltaCare?
DeltaCare is Delta Dental's DHMO (dental health maintenance organization) program. Participating general dentists receive monthly payments for each enrollee/family registered for their office regardless of the frequency of treatment. Participating specialists receive referrals from the enrollees' primary care dentist, and payment for authorized treatment is based on a fee schedule. Also, some plans may include enrollee copayments or supplemental payments from Delta Dental for certain services.
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What are the advantages of participating in DeltaCare?
Participating DeltaCare dentists are listed in our closed-panel directory, and members can select or be assigned to a provider's location. The monthly payment is guaranteed for all assigned enrollees; it does not depend on how many enrollees receive treatment or what services are rendered. Recruitment and participation are carefully monitored to ensure that dental offices receive an appropriate number of DeltaCare enrollees to provide a balanced patient base and income level.
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How do I know if a patient is eligible for DeltaCare benefits?
Delta Dental includes a roster of eligible enrollees assigned to that location with the monthly payment; however, individual eligibility can change within the month. Also, dentists who participate with DeltaCare are not automatically participating with DeltaCare USA. We recommend that you contact our customer service department to verify eligibility prior to rendering treatment. For DeltaCare customer service, call (800) 870-9988.
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Are claims filed for DeltaCare-covered patients?
Yes. Delta Dental is required to collect the utilization data for all services rendered to DeltaCare enrollees and send itemized reports to our groups. Providers can submit individual claim forms or provide a single, detailed report. Send claims and reports for DeltaCare enrollees to:
DeltaCare
PO Box 30383
Lansing, MI 48909-7883
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What if a patient has a condition that may require treatment by a specialist?
First, check the guidelines for referable services. If the service is eligible for referral, the enrollee can be referred to a DeltaCare participating specialist.
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Who pays the specialist for eligible treatment?
Delta Dental pays for authorized treatment based on the DeltaCare specialist fee. For some services, the enrollee may have a copayment.
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If I sign an agreement, how long do I have to remain participating? Am I free to terminate the agreement at any time?
Participating dentists can submit a written statement of termination at any time. The termination is effective at the end of the month following 90 days after Delta Dental receives the termination notice.
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If I have questions about participation with DeltaCare, whom do I call?
Our professional relations representatives are available to give you all of the information about participating with each Delta Dental program, facilitate the contracting process, and assist staff with Delta Dental claims administration. To schedule a personal visit to your office or request more information, call customer service at (800) 524-0149 or use our online request form.
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