Spring 2022

2.4 million members in Ohio
4 million claims processed in Ohio in 2021

Thank you for providing quality care to our members!
Because of you, more individuals have access to healthier smiles.

New Delta Dental members in Cincinnati

Greater Cincinnati-area dental offices may see an influx of Delta Dental members as multiple large groups have joined our network. 

Groups whose employees and covered members will soon have Delta Dental benefits or who recently joined Delta Dental include Cincinnati Children’s Hospital Medical Center, Hamilton County, MedPace and Kroger.

In the Greater Cincinnati area, there are nearly, 226,800 Delta Dental members who utilize the Delta Dental PPO™ and/or Delta Dental Premier® (DOT); networks.

Thank you for your ongoing dedication to your community and for providing high-quality care to all of your patients.  

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Get more with DOT

The Dental Office Toolkit® (DOT) empowers you to complete day-to-day tasks like submitting claims, looking up member benefits and updating office information, all without having to call customer service. This saves you valuable time and allows you to address needs faster.

You can submit claims to any Delta Dental plan through DOT, and our drop-to-pay rate for Michigan, Ohio and Indiana in 2021 was more than 95 percent. This means that the majority of claims submitted through DOT do not require any manual intervention! 

DOT is free for you to use, and if you don’t already have an account, registration is simple. Visit our website to learn how you can set up your DOT profile, read FAQ, find how-to guides and more. 

We continually look for areas of improvement in DOT that can make your experience even better. 

DOT testimonial

We use the Dental Office Toolkit every day, and it’s fabulous. My staff says all the time that they wish all insurance sites were as easy to work with. We love the ease of verifying benefits, reviewing claims history, and processing real-time claims and pre-authorizations. Our patients love that they know the exact amount they will owe. The benefit breakdowns are very thorough and there is never a grey area. I am the vice president of our local AADOM (American Association of Dental Office Management) chapter, and when I hear people complain about calling Delta Dental, the first thing I ask them is have they logged in to DOT? I honestly don’t know what our office would do without it.

-Angie Coffey, office manager, Dentistry @ University Pointe, West Chester, Ohio

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Breaking down NPIs

You may know that all covered health care providers, health plans and health care clearinghouses must use a 10-digit National Provider Identifier, but do you know which type of NPI you need and when you may need both?

  • Type 1 NPIs are for individual health care providers who are sole proprietors (not incorporated). 
    • An incorporated individual is a single health care provider who forms and conducts business under a corporation. A sole proprietor isn’t an incorporated individual because the sole proprietor didn’t form a corporation. If you’re a sole practitioner or solo practitioner, it doesn’t mean you’re a sole proprietor and vice versa.
  • Type 2 NPIs are for organization health care providers who are incorporated (incorporated individuals), group practices, clinics, county health departments and partnerships. 

Learn more about NPIs.

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Participating in the MA network

When you sign on to participate in the Delta Dental PPO™, Delta Dental Premier® or Delta Dental EPO™ networks, you get one more advantage—automatic participation in the corresponding Delta Dental Medicare Advantage™ network. 

You will be listed in the Medicare Advantage dentist search for those members, and services rendered are on the same fee schedule as the primary network you signed on to, whether that is Delta Dental PPO, Delta Dental Premier or Delta Dental EPO. The only difference when treating patients with Medicare Advantage versus a commercial plan is that you need to fill out a private pay form before providing any non-covered services. 

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Verifiying coverage

On the day a Delta Dental enrollee is to receive covered services, remember that you must verify their eligibility to receive those services and that you are responsible for informing them of any potential risks and/or benefits of recommended treatment and available alternatives prior to rendering services.

If that patient is a Medicare Advantage or Medicaid enrollee, don’t forget to obtain a signed private pay form from the patient if you will provide treatment that is not covered under their plan.

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Using provider pay form

If a Delta Dental Medicare Advantage or Medicaid member requires services not covered in their benefit plan, be sure to obtain a signed private pay form from that member before rendering services. 

Payment for non-covered services is the responsibility of the member or the responsible party. Before providing non-covered services, the fee must be discussed with the member or responsible party. Treatment can only be provided if and when they sign a private pay agreement, where they agree in writing to pay for the non-covered (or alternate) procedures. 

You may use any form for the private pay agreement as long as it includes the fees associated with the non-covered service, the responsible party’s signature and the date. (See Delta Dental’s sample form here). Keep the signed form in your files as Delta Dental may request a copy. 

The Delta Dental member’s or responsible party’s approval to proceed with non-covered services via the private pay form should be included in the patient’s record. If a member agrees to pay for a non-covered service, Delta Dental dentists will be held to the lesser of the submitted fee or the applicable Delta Dental fee schedule for any charges to the patient or responsible party.

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