Delta Dental of Virginia

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Wednesday, December 03, 2008

Claims

Q. What is Delta Dental of Virginia's (DDVA) claims address?
A. Claims for all Delta Dental of Virginia (DDVA) subscribers should be mailed to:
Delta Dental of Virginia
4818 Starkey Rd. SW
Roanoke, VA 24018

Q. What should be included on claim forms to DDVA?
A. Be sure to include the following on all claim forms:
-Subscriber's name and identification number,
-Patient's name and date of birth,
-The last five digits of the dentist's license number,
-The TIN or SSN that the dentist uses for IRS purposes,
-Dates of service (completion or delivery dates) for multiple visit services,
-Tooth numbers or quadrants and indicate tooth surfaces where applicable,
-Include complete dual coverage information including both the subscriber's identification number and date of birth, and attach the primary carrier's statement if applicable.

Q. What procedures require radiographs?
A. Radiographs should be submitted as follows: 1.) mounted, 2.) dated, 3.) labeled left to right, or with tooth numbers, and 4.) identified with both patient and dentist name and stapled to the top left corner of the claim form: Duplicate radiographs will not be returned unless requested. The following procedures require radiographs to be submitted with the claim:
-Surgical extractions
-4249, 4260, 4263, 4264, 4266, 4267, 4341
-Crowns, core build-up, cast or prefab post and core
-Partial Dentures
-Bridges
-4 canal RCT and retreat RCT
-Inlays, onlays, and veneers
-Implants

Q. What procedures require narratives?
A. The following procedures require brief, but detailed narratives to be submitted with the claim:
-9110 - palliative (emergency) treatment of dental pain
-4210,4211 - gingivectomy or gingivoplasty
-9940 and 7880 - indicating bruxism or TMJ
-Implants - indicating medical necessity

Q. What procedures require periodontal charting?
A. The following periodontal procedures require periodontal charting:
CDT Codes 4210; 4211; 4220; 4240; 4249; 4260; 4263; 4264; 4266; 4267; 4270; 4271; 4273; 4341; and 4342.

Q. What is the correct date of service for multiple visit procedures (root canals, crowns, fixed and removeable prosthetics)?
A. The correct date of service is the final fill date, the cementation date, and/or the delivery date. Delta Dental will only pay for completed dental services.

Q. If I have not received payment for a claim, should I send another copy to DDVA?
A. No, please do not send duplicate claims, as they just slow down the processing of claims. Please check with Benefit Services, our Automated Claim Information System (ACIS), or our website to determine if we have recieved your claim yet.

Q. How do I check the status of a claim?
A. Our Benefit Services Representatives are available Monday through Thursday from 8:15 a.m. to 6 p.m. and from 8:15 a.m. to 4:45 p.m. on Fridays at 800 237-6060 to assist you and your staff with claims status questions.

Delta Dental of Virginia's Automated Claim Information System(ACIS) is also available to check claims status. Simply dial 800 237-6060, press "2" at the main menu (for providers), and press "1" at the second menu to reach our automated system. You must have the Subscriber's Identification Number in order to access information. You may also access claim status via our website, using the Subscriber Idenfication Number. Once you are logged onto the Provider section of our website, select "Claims" from the menu on the left. For patients covered by other Delta Dental member companies, please contact the respective Delta Dental member company to verify claim status. Information on how to contact other Delta Dental member companies is available using the "Other Websites" link from our website.

Delta Dental National Coverage

Q. If I am a participating Delta Dental Provider, do I participate with all other Delta Dental member companies?
A. Yes, by signing a Delta Dental of Virginia Participating Provider Agreement, your participation is honored throughout the national Delta Dental system. Please keep in mind that if your patient is covered under a Delta Dental National Coverage plan, claims must be submitted to the appropriate Delta Dental member company for processing. You are still guaranteed direct payment and Virginia Maximum Plan Allowances (MPA) for these claims.

DeltaSelect TRICARE Retiree Dental Program

Q. If I am a participating Delta Dental provider, do I also participate with the TRICARE Retiree Program?
A. TRICARE Retiree Dental Program is now considered a Delta Dental PPO program. This means all participating Delta Dental dentists will receive direct payment according to Delta Dental of Virginia allowances. For those dentists that are participating with the Delta Dental PPO program, you are considered in-network for the TDRP patients.

Electronic Claims and Electronic Attachments

Q. Does DDVA accept electronic claims?
A. Yes, DDVA accepts electronic claims through Envoy, Healtheon/WebMD (formerly MedeAmerica) and CPS. Our Payer ID # is 54084 for Envoy and Healtheon/WebMD. Our CPS Payer ID # is CDVA1. We accept claims for payment, pre-determination, coordination of benefits and orthodontic claims electronically.

Q. What if I use a clearinghouse other than Envoy, CPS, or Healtheon/WebMD (formerly MedeAmerica)?
A. The clearinghouse you use will forward us a paper claim for processing. We plan to accept electronic claims from all clearinghouses in the very near future.

Q. Does DDVA accept electronic attachments?
A. Yes, DDVA accepts electronic attachments through National Electronic Attachments (NEA) and Rdental.com. Please note the attachment must be sent with an electronic claim. If you receive a "Request for Additional Information" from DDVA, you may submit an electronic attachment without a claim, if you submit the claim number with the attachment. Please do not send an electronic attachment without a claim, or without reference to a DDVA claim number, otherwise we will not be able to match the attachment with the claim.

Q. How do I find out more about filing electronic claims from my office?
A. Contact your software vendor.

Q. How do I find out more about filing electronic attachments from my office?
A. In order to submit electronic attachments, you will need equipment that produces an electronic copy of a document or image. The type of equipment and other requirements depends on which vendor you choose to support this capability. Two notable vendors are NEA and Rdental.

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Q. Should I also send a paper claim to DDVA if I have sent one electronically?
A. No, sending a paper copy or duplicate electronic claims only serves to slow down the processing of claims. Please feel free to contact our Benefit Services department to confirm receipt of your claim. Your software vendor should also be able to assist you with questions on the transmission of your claims.

Fee Filing

Q. Why is it important to keep my filed fees confidential?
A. Delta Dental pays claims based on the lessor of your fee on file, our Maximum Plan Allowance (MPA), or the amount submitted on the claim. DDVA also uses your fees in establishing MPAs, so it is very important to maintain current fees with DDVA.

Q. How can I update my fees with Delta Dental of Virginia?
A. You may print out a Confidential Fee Filing Form from the Forms section of our website. Instructions for completing this form are found on the second page of the form. Please be sure to also include a signed and dated W-9 form (which can be found in the Forms section of our website) with your fee update. You may also call our Provider Relations Department at 800 367-3531 and request a Confidential Fee Filing Form. Please note DDVA cannot accept computer print-outs of your fees. Your fees must be submitted on DDVA's Confidential Fee Filing Form.

Q. How often am I allowed to update my fees with Delta Dental of Virginia?
A. You are allowed to update your fees once every twelve (12) consecutive months. To determine when you last updated your fees, refer to the "Last Date Fees Filed" column of the Facility Information Report which can be accessed by selecting "Provider" from the left menu on our website. You may also call our Benefit Services Department at 800 237-6060 and ask when your fees were last filed.

Participation

Q. How do I become a participating Delta Dental Premier dentist?
A. In order to become a participating Delta Dental Premier dentist, you must sign a Participating Dentist Agreement, complete a Confidential Fee Filing Form, Individual Practicioner Profile, a Facility Profile for each location, and a W-9 form. Send the above information along with a copy of your DEA license, your work history for the last five years, and proof of malpractice insurance coverage to DDVA. Copies of these documents can be found in the Forms section of our website, or you may contact our Provider Relations Department at 800 367-3531 and request a Delta Dental Premier participation packet.

Q. What are the advantages of participating with Delta Dental Premier?
A. Participating Delta Dental Premier dentists are guaranteed direct payment for services rendered to Delta Dental Premier patients. This will save you a significant amount of time as well as reduce your billing costs. Your name is also published as a participating Delta Dental Premier dentist in directories sent to our groups, as well as on our website. Delta Dental Premier subscribers generally have reduced out-of-pocket expenses when they visit participating Delta Dental dentists.

Q. What reimbursement will I receive as a participating Delta Dental Premier dentist?
A. DDVA’s reimbursement is based on the Maximum Plan Allowance (MPA) concept. Our MPAs are derived from participating dentist’s filed fees, and are based on geographical regions and specialty training. Due to the confidential nature of the Fee Filing Forms, and provisions of federal anti-trust laws, DDVA is prohibited from publishing MPAs.

Q. How do I become a participating Delta Dental PPO dentist?
A. Please call Provider Relations at 800 367-3531, to get a Delta Dental PPO Fee Schedule and Contract.

Q. How do I become a participating DeltaCare dentist?
A. DeltaCare is our managed care program and we require that participating providers be in practice for a minimum of five years. Please call Provider Relations at 800 367-3531 to request information.

Patient Benefits

Q. How do I determine patient benefits and eligibility?
A. Our Benefit Services Representatives are available Monday through Thursday from 8:15 a.m. to 6:00 p.m. and from 8:15 a.m. to 4:45 p.m. on Fridays at 800-237-6060 to assist you and your staff.
Delta Dental of Virginia's Automated Claim Information System (ACIS) is also available to check eligibility and claims status. Simply dial 800 237-6060, press "2" at the main menu (for providers), and press "1" at the second menu to reach our automated system. You must have the Subscriber's Identification Number in order to access information.
You may also access patient benefits and eligibility via our website, using the Subscriber Identification Number, first name, and date of birth. Once you are logged onto the Dentist Connection section of our website, you will be able to determine covered benefits, co-pays, age limits, etc.
For patients covered by other Delta Dental member companies, please contact the respective Delta Dental member company to verify patient benefits and eligibility. Information on how to contact other Delta Dental member companies is available using the "Other Websites" link from our website.

Which Delta Dental Program?

Q. What is the difference between Delta Dental Premier, Delta Dental PPO, and DeltaCare?
A. Many times patients say "I am covered with Delta." It is important to ask them which program they are covered under. Determining this in advance will enable the patient to know if you participate in their program, and will avoid any surprises or misunderstandings.
Delta Dental Premier or Delta Dental Premier National Coverage is our traditional fee-for-service program. You are guaranteed direct payment based on the lessor of your filed fee or Virginia MPAs, regardless of which Delta Dental member company processes your claim. Subscribers with Delta Dental Premier coverage have financial incentive to seek services from a participating Delta Dental Premier dentist.
Delta Dental PPO and Delta Dental PPO National Coverage is our reduced fee-for-service program commonly referred to as a PPO. Delta Dental PPO dentists agree to accept payment based on the lessor of their filed fee or the Delta Dental PPO fee schedule. Just as in Delta Dental Premier, dentists file claims and received direct payment, regardless of which Delta Dental member company processes the claim. There is a financial incentive for Delta Dental PPO patients to choose a participating Delta Dental PPO dentist. Unless the group contract specifies otherwise, Delta Dental PPO patients may choose to incur higher out-of-pocket expenses and seek services from a Delta Dental Premier only dentist. Participating Delta Dental Premier dentists agree to file claims, accept Virginia MPAs, and received direct payment for Delta Dental PPO patients, just as they do for Dental Dental Premier patients.
DeltaCare and DeltaCare National Coverage is our managed care program commonly referred to as a DHMO. Reimbursement is based on capitation and member co-payments, and DeltaCare pays an encounter fee per patient per visit. DeltaCare patients must seek care from their selected DeltaCare dentist, and any necessary specialty care referrals must be pre-authorized by DeltaCare. If you are not the patient's selected DeltaCare dentist, please ask the patient to call DeltaCare at 800 862-0838. Any services rendered by a dentist other than their selected DeltaCare dentist becomes the patient's full financial responsibility.
For more information on participating with any of the above programs, please see the Participation section of the FAQs on this website.