Dear providers:
We’ve reimagined our occasional newsletter to make it a monthly must-read full of policy updates and practical tips. Check out this month’s communication designed to help you stay informed, save time and focus on patient care.
Submit claims through DOT or your clearinghouse
For members enrolled in adult Medicaid and Healthy Michigan Plan, Medicare Advantage, Healthy Kids Dental or Michigan Coordinated Health, dental claims should be submitted directly to Delta Dental or your clearinghouse using payer ID DDPMI. Claims submitted with the incorrect payer ID will result in denials.
Please do not submit claims to the health plan the member is enrolled in.
Pre-service and post-service claims can be submitted through any of the following:
- Directly through Dental Office ToolkitTM (DOT)
- Transmitted through a clearinghouse
- Post-service only: Sent through the mail to Delta Dental Government Programs (P.O. Box 9298, Farmington Hills, MI 48333-9298)
Code D2940
Effective June 1, Delta Dental of Michigan requires the inclusion of the applicable tooth number and surface(s) for Code D2940 when submitting claims. This aligns with expectations of both the Michigan Department of Health and Human Services and the ADA. If both the tooth number and surface(s) are not submitted for Code D2940, the claim will be denied.
For more information, please refer to Appendix 3: ADA Guide to Dental Procedures Reported with Area of the Oral Cavity or Tooth Anatomy (or Both).
Reminder: Appointment timeliness
If you are scheduling patients who have Healthy Kids Dental, Healthy Michigan Plan or MI Health Link benefits, remember that they must be seen or scheduled within a set time frame.
These benchmarks are based on treatment urgency and are required by the Michigan Department of Health and Human Services. Find these benchmarks in your participation contract or below for general practitioners or pediatric dentists:
- Urgent care—see within 48 hours
- Routine services—schedule within 21 business days
- Preventive services—schedule within six weeks
- Initial appointment—schedule within eight weeks
- Emergency services—provider must be available immediately, 24/7
Michigan wins Healthy Kids Dental (HKD)
Delta Dental of Michigan will once again be the sole source carrier for HKD when the new contract begins Oct. 1. Delta Dental of Michigan has been a dental vendor for the HKD program since its inception 25 years ago and historically championed its expansion across the state, supporting our mission to improve oral health.
Electronic IR and EFT
Submit and respond electronically
As of May 31, providers with an active DOT account are only able to submit and respond to Information Requests electronically through DOT. All other DOT functionality remains the same.
Sign up now
As of June 1, payment via EFT is required. Please sign up now to ensure continued compliance with your provider agreement and to ensure there is no delay in payments to you.
Need assistance?
If you need assistance with DOT, please call Toolkit Support at 866-356-0301. If you have other questions, please contact your professional services representative.
New provider wait time standard
The Centers for Medicare and Medicaid Services has adopted a new provider wait time standard to ensure that new or existing patients who obtained dental coverage through the federal exchange can obtain a dental appointment with any in-network Delta Dental PPO™ or Delta Dental Premier® dentist (including specialists) within 30 business days of the patient requesting an appointment from the office. If you need help meeting this standard, please call your professional services representative.
Next issue of Best Practice magazine
The next issue of Best Practice magazine will be published this summer. The theme, “Access into Action,” will showcase stories about how access to resources leads to real use and benefits for members and providers.
Emergency dental care
Unscheduled dental services necessary to treat a life-threatening condition in the mouth or face include services to address uncontrolled bleeding, spreading infection, severe debilitating pain or traumatic injury to the mouth or face.
Retrospective review of codes normally requiring prior authorization may be submitted for review when urgent or emergency care is justified. Please remember to include a remark indicating ‘emergent’ or ‘emergency’ in the remarks box when submitting these types of claims.
