FAQs | Providers

 

Providers


Frequently Asked Questions

Claims

Q. Does Delta Dental of Virginia accept electronic claims?

A. Yes, we accept electronic claims from a variety of clearinghouses, including DentalXChange, Change Healthcare and Tesia. Our Payer ID# is 54084. Delta Dental Premier and Delta Dental PPO participating providers can also submit claims online by logging into our secure provider page.

Q. What if I use a clearinghouse not included in your list of accepted clearinghouses?

A. Delta Dental of Virginia can accept claims from a variety of clearinghouses, including DentalXChange, Change Healthcare and Tesia. If you use a different clearinghouse than what is listed here, contact our Claims Department to see if we can accept claims from your current clearinghouse. You may also submit claims online in real-time through our secure provider site or by printing them to paper and mailing or faxing them to us at:

Delta Dental of Virginia
ATTN: Claims Department
4818 Starkey Rd. SW
Roanoke, VA 24018
Fax: 540-491-9717

Q. How do I submit claims to Delta Dental?

A. We can accept your claims electronically, by fax, or by mail. To submit claims electronically log into our secure provider site. Claims can also be mailed or faxed to:

ATTN: Claims Department
Delta Dental of Virginia
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, address, 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 Interactive Voice Response System (IVR) by dialing 800-367-3531 and pressing “1" for claim status. 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 NEA attachment number must be referenced on the claim in the notes section. 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. Check with your practice management software vendor for more details. You can also contact National Electronic Attachments (NEA) for more information.

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
  • 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 refer to your Provider Manual or call us at 800-367-3531.

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 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:

  • Implants - Indicating medical necessity
  • Any procedure code ending in 99 – Miscellaneous codes
  • Any CDT procedure code that has 'by report' in the descriptor
  • 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; 4230; 4231; 4240; 4241; 4245 ; 4260; 4261; 4263; 4264; 4266; 4267; 4270; 4273; 4275; 4276; 4277; 4278; 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.

Participation

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 Delta Dental of 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. Employers actively encourage their employees to select Delta Dental's PPO network dentists because their out-of-pocket expenses may be lower.

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. What are the advantages of participating with Delta Dental PPO?

A. Delta Dental PPO providers enjoy all the advantages of a Delta Dental Premier provider. Additionally, PPO plans are the most common plan chosen by employer groups and their employees are encouraged to seek care from Delta Dental PPO providers because, when they do, their out-of-pocket costs are usually lower. Employers and employees alike are becoming savvier than ever, resulting in more patients choosing PPO.

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

A. Delta Dental of Virginia’s PPO reimbursement is based on a published fee schedule. Fees are based on geographical regions and specialty training.

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

A. To become a Delta Dental participating provider, 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 “3.”

Q. How can I view the PPO fee schedule for my region?

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 patients' 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.

Fees

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:

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 us at 800-367-3531 and ask when your fees were last filed.

Payment

Does Delta Dental of Virginia offer payment via Direct Deposit?

A. Yes, we offer free direct deposit to all dentists, whether you submit claims electronically or by paper. Learn more about direct deposit and sign up today to get your claims payments transferred directly from Delta Dental to your checking or savings account.