Delta Dental Premier® Participation FAQs
What is Delta Dental?
Delta Dental is a nonprofit, group dental benefit administrator. For more than 60 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.
What is Delta Dental Premier®?
Delta Dental Premier® is a standard fee-for-service dental benefits program. Delta Dental reimburses participating dentists directly based on their submitted fees and our maximum approved fee. Members are responsible for their copayment and deductible (if any) and charges for any non-covered services.
What is the Delta Dental Premier® network?
The network is made up of 155,000 dentists participating throughout the United States and its territories—four out of five dentists participate in one or more Delta Dental programs.
-Delta Dental Plans Association, 2020
What are the advantages of participating in Delta Dental Premier®?
Just a few benefits of participation include direct payment, new and retained patients who have the motivation and financial support to seek dental care, and Delta Dental's superior service and assistance.
Is Delta Dental Premier® a capitation/DHMO or PPO program?
No, it is neither. Delta Dental pays participating dentists directly for each covered service rendered based on the lesser of the submitted fee or Delta Dental's maximum fee allowance, not a published fee schedule or monthly dollar amount. Eligible members can receive care from any licensed dentist, but they can save on out-of-pocket costs and administration by choosing a Delta Dental Premier® dentist.
What do I agree to when I sign an agreement?
Participating dentists agree to follow the Uniform Requirements (which can be reviewed prior to signing an agreement); abide by the processing policies (which can be reviewed prior to signing an agreement); charge members their applicable copayments; and accept payment directly from Delta Dental.
How are participating dentists paid in the Delta Dental Premier® program? What is the fee policy?
Participating dentists are paid for each covered service rendered. The fee policy means that Delta Dental's payment to participating dentists is based on the lesser of your submitted fee or the maximum fee that Delta Dental approves for a given procedure in a given region of the state for all Delta Dental-covered patients.
How often are fees reviewed or increased?
The fees are reviewed annually and updated as necessary.
Can the patient be billed the difference between the amount that Delta Dental approves and the submitted fee?
No, that difference is not chargeable to the patient. Reimbursement may come from Delta Dental, the patient or a combination of both parties, but the total amount charged cannot exceed the approved amount.
How do I know if the fees determined by Delta Dental will be acceptable for my practice?
Delta Dental can provide you with a fee analysis before you sign an agreement. The analysis will compare your 60 highest Delta Dental utilized dental procedures and the fees submitted by your office to Delta Dental's maximum approved fees.
How do I know if a patient is eligible for Delta Dental Premier® benefits?
You can verify eligibility and access benefits and claims information online through the Dental Office Toolkit®, or you can call 800-524-0149 and use DASI, our automated voice response system. You may also request a summary of dental benefits by selecting the FaxBack option. For patients that have dental coverage through a national group, visit the Delta Dental portal at www.deltadental.com.
Am I expected to file claims for Delta Dental-covered patients?
Yes. To make things easier for you, Delta Dental offers several convenient solutions. For submitting claims electronically at no charge, use the Dental Office Toolkit®. You may use a clearinghouse that will usually charge a per claim or monthly fee, or you may mail paper claims to:
PO Box 9085
Farmington Hills, MI 48333-9085
Do I need approval to refer a patient to a specialist?
No. Prior approval is not required when you refer a patient to a specialist. However, we do suggest that you refer your patients to a Delta Dental Premier® participating specialist to minimize your patients' out-of-pocket costs. To get a list of participating specialists in your patients' area, call DASI at 800-524-0149, or use our online dentist directory.
How do Delta Dental-covered patients and members know that I am a Delta Dental Premier® participating dentist?
To assist new and existing Delta Dental members in locating your office, we provide listings of participating dentists on our websites, our online Member Portal and through DASI.
If I sign an agreement, how long do I have to remain participating? Am I free to terminate the agreement at any time?
The agreement remains in effect until you decide to terminate it. We require participating dentists to provide a 30-day written notice before resigning from a Delta Dental program.
Can I participate in more than one Delta Dental program?
Yes, you can participate in one or both of our programs: Delta Dental Premier® and Delta Dental PPO™ .
If I have further questions about participation, 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, contact your Provider Relations Representative listed on this territory map.