Providers | Delta Dental of Virginia

Providers


Frequently Asked Questions

Q.Does Delta Dental of Virginia accept electronic claims?

A. Yes, we accept electronic claims through MDE, Emdeon and G&C. Our Payer ID# is 54084.  Delta Dental Premier and Delta Dental PPO participating providers can also submit claims online by logging in to our secure provider page. Simply select a patient and choose to submit a new claim – it’s that easy! If you are having trouble submitting a claim through your current software system, please call our Provider Relations department at 800-367-3531 and press “7.”


Q. What if I use a clearinghouse other than Envoy, CPS, or Healtheon/WebMD (formerly MedeAmerica)?

A. Delta Dental of Virginia accepts claims through Emdeon, MDE and G&C.


Q. How do I submit claims to Delta Dental?

A. You can now submit claims to Delta Dental online in real-time through our secure provider site! Delta Dental is able to provide real-time claims submission through our website by working closely with MDE, our clearinghouse and dental office technology sister company. MDE provides efficient, robust real-time transaction technology that connects dental practices and payers enabling all to maximize efficiency, improve patient interactions, optimize cash flow, and ultimately create a retail-like experience in the dental office.

Log in to submit claims online.

Claims can also be mailed or faxed to:
Delta Dental of Virginia
ATTN: Claims Department
4818 Starkey Rd. SW
Roanoke, VA 24018
Fax: 540-491-9717


Q. What should be included on claim forms to Delta Dental?

A. Be sure to include the following on all claim forms:

  • Subscriber's name, date of birth and identification number
  • Patient's name and date of birth
  • Patient’s relationship to subscriber
  • The dentist's complete license number
  • The dentist’s EIN (TIN or SSN)
  • National Provider Identifier (NPI)
  • Narratives, X-rays and intra-oral photos (please refer to your provider manual for procedures requiring this documentation)
  • Dates of service (completion or delivery dates) for multiple visit services
  • Tooth numbers or quadrants and indicate tooth surfaces where applicable
  • Complete dual coverage information, including the subscriber's identification number and date of birth, and attach the primary carrier's statement (if applicable).

Q. Should I also send a paper claim to Delta Dental if I have sent one electronically?

A. To ensure quick processing, please do not submit paper claims in addition to electronic claims. You can check the status of your submitted claims quickly and easily by logging in to our secure provider site.


Q. How do I check the status of a claim?

A. You can check the status of your claims 24/7 through our secure provider site. Simply log in and a list of your pending claims will appear. You can also check claim status through our Automated Claim Information System (ACIS) by dialing 800-237-6060 and pressing “7” at the main menu and then “1.” Please do not send in duplicate claims if the claim is showing in our system, as it will delay the process.


Q. Does Delta Dental of Virginia accept electronic attachments?

A. Yes, we accept electronic attachments through National Electronic Attachments (NEA). Please note, the attachment must be sent with an electronic claim. If you receive a "Request for Additional Information" from Delta Dental, 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 Delta Dental claim number.


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.


Q. What procedures require radiographs?

A. The following procedures require radiographs to be submitted with the claim:

  • Some periodontal procedures
  • Surgical extractions
  • Crowns, core build-up, cast or prefab post and core
  • Partial Dentures
  • Bridges
  • Inlays, onlays and veneers
  • Implants

If you have any questions about whether a specific procedure requires radiographs to be submitted with the claim, please call our Provider Relations department at 800-367-3531 and press “7.”

Radiographs should be submitted as follows:

  • Mounted,
  • Dated,
  • Labeled left to right, or with tooth numbers, and
  • Identified on the X-ray with the patient name, dentist name, and dentist address and phone number.

Radiographs will not be returned unless submitted with a self addressed return envelope. Please make sure to send copies of your original X-rays. Delta Dental is not responsible for returning X-rays and will not do so unless they are submitted with a self-addressed return envelope.


Q. What procedures require narratives?

A. The following procedures require narratives to be submitted with the claim:

  • 9110 - Palliative (emergency) treatment of dental pain
  • 2950 - Core build-up, including any pins
  • 4355 - Full mouth debridement
  • 4210,4211 - Gingivectomy or gingivoplasty
  • 9940 and 7880 - Indicating bruxism or TMJ
  • Implants - Indicating medical necessity
  • Any procedure code ending in 99 – Miscellaneous codes
  • Other procedures that are unclear or require dental necessity rationale

Q. What procedures require periodontal charting?

A. The following periodontal procedures require periodontal charting: CDT Codes 4210; 4211; 4220; 4240; ; 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 removable 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 participate with Delta Dental of Virginia, 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.


Q. What is the difference between Delta Dental Premier, Delta Dental PPO, and DeltaCare?

A.Delta Dental Premier is the largest dental network in Virginia and across the nation. This traditional fee-for-service program guarantees participating providers direct reimbursement based on the least of their filed fee, submitted fee or Virginia’s Maximum Plan Allowance (MPA). Subscribers with Delta Dental Premier plans experience lower out-of-pocket costs when visiting a Delta Dental Premier participating provider.


Delta Dental PPO is our preferred provider network. This reduced fee-for-service program guarantees participating providers direct reimbursement based on the lesser of their filed fee or the Delta Dental PPO fee schedule. Subscribers with Delta Dental PPO experience the lowest out-of-pocket costs when visiting a Delta Dental PPO dentist.


DeltaCare is our managed care program, commonly referred to as a DHMO (Dental Health Maintenance Organization). Reimbursement is traditionally based on capitation and member copayments. Subscribers with DeltaCare 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 him/her to call DeltaCare at 800-862-0838 for participation information. Any services rendered by any dentist other than the patient’s selected DeltaCare dentist becomes the patient’s full financial responsibility.


Note: Please make sure to check your patient’s ID card to ensure that you participate in the Delta Dental network covered by their plan. Get more information on our plans and networks.


Q. What are the advantages of participating with Delta Dental Premier?

A. Delta Dental Premier participating providers 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 provider 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 Delta Dental Premier participating providers.


Q. What reimbursement will I receive as a Delta Dental Premier participating provider?

A. Delta Dental of Virginia’s reimbursement is based on the Maximum Plan Allowance (MPA) concept. Our MPAs are derived from participating dentists’ 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, Delta Dental is prohibited from publishing MPAs.


Q. How do I become a Delta Dental Premier participating provider?

A. To become a participating Delta Dental Premier dentist, please complete and submit the following:

If you have questions on becoming a participating provider, call our Provider Relations department at 800-367-3531 and press “7.”


Q. How do I become a Delta Dental PPO participating provider?

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 DeltaCare participating provider?

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.


Q. If I am a participating Delta Dental provider, do I also participate with the TRICARE Retiree Program?

A. DeltaSelect 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 TRICARE Retiree Dental Program patients.


Q. How do I determine patient benefits and eligibility?

A. You can access your patients’ benefits quickly and easily by logging into our secure provider site, where you can check benefits and eligibility, claims status and payments, submit claims online and organize your appointments using our online scheduler.


Q. Why is it important to keep my fees updated?

A. Delta Dental pays claims based on the lowest of the following three:

  • Your fee on file
  • Our Maximum Plan Allowance (MPA)
  • The amount submitted on the claim

Keeping your fees updated with Delta Dental assures you get an accurate payment and that we have accurate data for increasing the MPA’s for your region.


Q. How can I update my fees with Delta Dental of Virginia?

A. Update your fees by filling out and submitting the following:

  • Confidential Fee Filing Form
  • W-9

Please note, we cannot accept computer print-outs of your fees. Your fees must be submitted on our 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, log into your secure provider site, click on the "View Your Profile" link in the top left-hand corner of the page, then click on the "View Facility Report" button. You may also call our Benefit Services Department at 800-237-6060 and ask when your fees were last filed.