Frequently Asked Questions Providers
Delta Dental of Minnesota


 

Frequently Asked Provider Questions - General



Who is eligible to become a Delta Dental participating dentist?

Any dentist licensed under the laws of any state in the United States is encouraged to become a Delta Dental participating dentist. [Return]



What is the purpose of a Participating Dentist Agreement?

Through the Participating Dentist Agreement, Delta Dental and the dentist work together to provide affordable dental care. While each Delta Dental network has its own unique agreement, some of the common agreement provisions include:

  • You agree to accept direct payment from Delta Dental.
  • You agree that subscribers will not be charged more than the pre-established coinsurance amount. In other words, you agree not to balance bill patients any difference between the Delta Dental approved amount and your usual fee, if any.
  • You agree to fee verifications and periodic record reviews.
  • You agree to submit diagnostic aids (such as X-ray films) as necessary to help Delta Dental verify that treatment is covered by the group contract.
  • You agree to cooperate with state or local peer review committees and with dental consultants.
  • You agree to keep Delta Dental MN up to date with your current practice information and to re-credential every 3 years.
[Return]

How does Delta Dental determine the dentist’s reimbursement level?

Delta Dental pays participating dentists the appropriate percentage of the fee submitted on the claim and the fee table maximum, whichever is less. Payment of the dental plan’s obligation is made directly to the participating dentist. Delta Dental participating dentist accept this reimbursement s payment in full for services covered under the plan. [Return]

Does Delta Dental require credentialing?

Delta Dental believes in nurturing long-term partnerships with highly qualified individuals and organizations who share our commitment to quality dental care and services. As part of our commitment to quality, Delta Dental has a formalized credentialing process through which we objectively evaluate dentists against formalized standards. [Return]

I’m interested. How do I contact Delta Dental?

To speak with a Network Services Representative about network participation, call 1-800-328-1188 ext. 4170. [Return]

How should I submit procedures that are being done for cosmetic purposes?

Per the Delta Dental Participating Dental Provider Policies and Procedures, the following applies only to commercial plan claims: Participating Dentists should not submit claims for non-covered services. If a Subscriber requires a denial for non-covered services, a Participating Dentist may request a manual denial by contacting Delta Dental. [Return]

What do I do if I haven’t received my direct deposit payment or electronic remittance?

Please contact Customer Service at 1-800-448-3815 from 7 a.m. to 7 p.m. CST if you have found that your direct deposit or associated electronic remittance has been missing after four (4) business days. Our team will ask you to provide the following:
  • subscriber ID
  • date of service
  • payment number
  • account number
  • claim number
  • direct deposit issue date

Our Customer Service team will look into your missing payment. Within 5-7 business days, a Customer Service team member will reach out with an update on your inquiry and explain the next steps. [Return]



Frequently Asked Provider Questions - Claims



Where can I find claims history information on the Delta Dental website?

To find information on claims submitted by your office: On the left side of any webpage, click on Dentist and select Sign In. Set up a new user account or sign in using your username and password. Once inside the application, from the Menu page click Subscriber Search and enter your patient’s subscriber ID and date of birth to receive the Coverage Summary page. In the upper right side of the screen you will see a link to Claims Inquiry. On the Claims Inquiry page, click the patient’s name to see a history of claims and procedures we’ve processed from your office. Please note that you will only have access to claims history information from your office.



Some employers provide more detailed information than others. Why?

We want the information we post on the web to be as accurate as possible. However, because benefits can vary so much between groups, we sometimes need to generalize to remain accurate.



Where can I find the dates a patient is eligible for benefits for a procedure?

Please note that not all group benefits can be displayed on the web. To access this information, on the top of any webpage click on Dental Professionals under Login to your Account. Set up a new user account or sign in using your username and password. Once inside the application, from the Menu page click Subscriber Search and enter your patient’s subscriber ID and date of birth to receive the Coverage Summary page. If the subscriber’s benefits can be displayed online, in the middle on the right side of Coverage Summary you will see a column for Benefits Inquiry. Click the View link. Once inside the Benefits Inquiry application, select Frequency Limits for Common Services. Here you will find a chart of common procedure codes and billable frequencies. View the patient’s claim history to determine whether he or she is eligible to receive the procedure.



Where is the patient’s address displayed on the website?

The patient’s address is HIPAA-protected information, and therefore is not displayed on our website.



Where is the claims processing address displayed on the website?

To find helpful contact information for a variety of questions, please go to the Contact Us link on any webpage to view phone and address information.



Is waiting period information available on the website?

Yes.



Is a listing of reason denial codes available on the website?

Not at this time.



Frequently Asked Provider Questions - NPI



What is the NPI?

The National Provider Identifier (NPI) is part of the Health Insurance Portability and Accountability Act (HIPAA). The NPI regulation establishes one unique identifying number for each health care provider. This simplification measure will pare down the number of identifiers currently used in health care transactions. [Return]



What are the advantages of the NPI?

Use of the NPI will have several advantages, including:

One unique provider identifier for all health plans to utilize

A permanent provider identifier that will not change in the event of practice relocation or changes in specialty

An easier process for health plans to track transactions and avoid duplication [Return]



How is my NPI determined?

The NPI is a random ten-digit number (nine digits plus a check digit to detect keying errors). It never expires. It contains no inherent information about the provider, such as state of residence or license number. NPI numbers are administered by the Centers for Medicare and Medicaid Services (CMS), which has contracted with the National Plan and Provider Enumeration System (NPPES). The federal government is also responsible for assisting providers in completing the application and resolving problems associated with an NPI. [Return]



Who is required to apply for an NPI?

The broad definition of health care "provider" in the federal regulation encompasses all who provide health care services. Please note: Although dental assistants and hygienists are "providers" and are thus eligible to obtain an NPI, they are only required to do so if they submit claims for their services.

In Minnesota: Because of Minnesota Statute 62J.54, all Minnesota providers must use their NPI on paper and electronic claims. Therefore, all billing providers in Minnesota must apply for an NPI and understand the requirements for its use.

In other states: Use of the NPI by providers is required for electronic claims only.

There are two types of NPIs.

Type 1: Individuals (such as physicians, dentists and pharmacists) – No two individuals can have the same NPI and no individual person can have more than one Type 1 NPI. Type 2: Organizations or Corporations (such as hospitals and clinics) – Only needed if the organization or corporation does the billing. You will use the NPI to designate:

Treating Provider – always use the Type 1 NPI of the dentist providing care. This cannot be a Type 2 NPI. Billing Provider – the entity doing the billing – Use Type 1 NPI if the chief dentist does the billing for all dentists. – Use Type 2 NPI if the organization or corporation does the billing. General rules:

If the Billing Provider is different from the Treating Provider, and the Billing Provider is a corporation or organization, then the corporation should get a Type 2 NPI. Practices that are sole proprietorships should not get a Type 2 NPI. The proprietor should get one Type 1 NPI and use it for both the Billing Provider and Treating Provider. If the Billing Provider is different from the Treating Provider, and both are individual dentists, submit the appropriate Type 1 NPI in each field. [Return]



Will the NPI replace other numbers I use?

The NPI will replace other identifying numbers currently used in electronic transactions, such as your:

Numbers issued by plans and insurers (e.g. Blue Cross and Blue Shield number)

Medicaid provider number

Medicare provider number

CHAMPUS number

Other "legacy" identification numbers

The NPI will not replace numbers used for purposes other than general identification, such as your:

Social Security Number

DEA number

Taxpayer ID number

Taxonomy number

State license number

The NPI will replace all other identification numbers, but your Taxpayer ID number (or Social Security Number) will still be required for 1099 purposes. [Return]



How do I apply for my NPI?

You only apply for your NPI once, and your NPI is permanently assigned for your lifetime. There is no cost to apply. You may apply for your NPI either:

Online: Complete a web application and submit it electronically

On Paper: Print an Adobe Acrobat (PDF) version of the application and mail it to the address provided. You may also call NPPES to have an application sent to you. Call 1-800-465-3203 or TTY 1-800-692-2326.

When you apply for your NPI, you will be asked to provide your 10-digit taxonomy code. For quick reference, here are the dental taxonomy codes:

General Practice – 1223G0001X

Dental Public Health – 1223D0001X

Endodontics – 1223E0200X

Oral and Maxillofacial Pathology – 1223P0106X

Oral and Maxillofacial Radiology – 1223X0008X

Oral and Maxillofacial Surgery – 1223S0112X

Orthodontics and Dentofacial Orthopedics – 1223X0400X

Pediatric Dentistry – 1223P0221X

Periodontics – 1223P0300X

Prosthodontics – 1223P0700X

Denturist – 122400000X

After you receive your NPI, you must furnish any updates to the NPPES. If any of the data you submitted on your application changes, notify NPPES within 30 days of the change. You may receive notices about the NPI from other health and dental plans, but your unique NPI is used with all plans. Remember to notify each dental plan of your NPI separately. [Return]



What do I do with my NPI once I have it?

If you haven’t done so already, please send us your NPI now so it won’t affect your claims. Please remember to continue to include your TIN and License on the claim. Other health and dental plans may have differing timelines for NPI implementation, so take notice of each plan's requirements. In addition, you will want to contact your clearinghouse for instructions about their transition plans for using the NPI. [Return]

Where can I go for additional help and information?

This website will have NPI updates so check back periodically. Here are some helpful Internet resources:

The federal government's NPI website

NPI application help (Phone assistance is available at 1-800-465-3203) [Return]


Frequently Asked Questions - Remittance Advice





What is an 835/Electronic Remittance Advice (ERA)?

The 835/Electronic Remittance Advice is an electronic version of the provider Explanation of Benefits (EOB). [Return]



How will I receive the 835/ERA?

This will be sent to you by the same clearinghouse that you submit your electronic claims to. [Return]

How will this be loaded into my Practice Management System?

Check with your software vendor to see what capabilities they offer. Some software vendors have the capability of automatically posting this data directly into your accounts receivables. Others may only provide a display image that can be printed and would need to be manually entered. [Return]



Will I be charged for the 835/ERA?

Check with your clearinghouse and software vendor to determine what, if any, cost there may be for you. Delta Dental does not charge a fee for the 835/ERA. [Return]



Can I still receive paper?

If you are a Minnesota provider, you must comply with the MN Statute 62J requiring all provider EOBs be electronic. If you need duplicate EOBs, you can obtain a copy by visiting our forms and downloads sections. You can also contact Customer Service at 1-800-328-1188. [Return]



Will the 835/ERA differ from paper?

In most areas, the 835/ERA supplies additional information which aids in the automatic posting process. However, the processing policies are more general than what is currently on the paper EOB. If you have trouble with interpreting the processing policies, you can refer to the member’s ID card for information to contact Customer Service or a reference to a Website for access to view the claim online. [Return]



Can I discontinue the paper EOBs I receive?

Yes, for providers based in Minnesota, please contact Delta Dental of Minnesota in writing to request that the paper EOBs be discontinued. This request should be sent to Professional Services at PO Box 9120, Farmington Hills, MI 48333-9120. [Return]