For all providers
News and information for all participating commercial, Medicaid and Medicare providers
Dental Office Toolkit™ (DOT) enhancements
We care about your time. Providers can now manage claims more efficiently with enhanced search and filtering tools, sortable columns, expanded treatment details and CSV export capabilities. These improvements make it easier to find, review and track claims, helping reduce administrative burden and streamline day-to-day claims management.
Cracking the code: D4249 (crown lengthening) vs. D4212 (gingivectomy for restorative purposes)
Definitions
According to the American Dental Association’s Code on Dental Procedures and Nomenclature, clinical crown lengthening involves hard tissue (bone) removal in addition to soft tissue removal. This involves a periodontal flap and alteration of the crown to root ratio.
D4249
When doing a crown lengthening, the appropriate code is D4249. Documentation for D4249 should clearly support the restorative need for crown lengthening, the flap and the removal of supporting bone.
Quick tip:
If no bone is removed, D4212 is generally the appropriate code. If bone removal is required to expose additional tooth structure for restoration, use D4249.
Reminder: EFT requirement effective Sept. 1
Your provider agreement was amended to require payment via EFT starting Sept. 1. EFT is a faster, safer and simpler way to get paid. Enroll in EFT to:
- Receive payments faster, often within 48 hours of claim submission.
- Enhance security with direct deposits, encryption and multi-factor authentication.
- Reduce administrative tasks and spend more time focusing on patient care.
We appreciate your continued partnership. 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 or see our EFT FAQ.
For Medicaid and Medicare providers only
News and information for all participating Medicaid and Medicare providers
Meet your representatives at the ODA Annual Session
The countdown is on for the ODA Annual Session in Columbus, Sept. 17-19. As you explore the Exhibit Hall and continuing education opportunities, take time to visit our team. It's a great chance to meet your reps and learn about resources available to your practice.
Register or explore the schedule at oda.org. We look forward to seeing you!
Sept. 24: Ohio Medicaid provider training
Our next Ohio Medicaid provider training is Sept. 24, 3-4 p.m. ET, covering topics including noncovered services, prior authorization versus prepayment review, provider disputes, documentation requirements and adjustments coming to DOT.
Registration is required and can be completed using the form in your email invite. You’re encouraged to submit questions on the form prior to the training. A meeting link will be emailed to you shortly before the session.
Reminder: Urgent prior authorization requests
To ensure timely and appropriate review of prior authorization and other review requests, requests submitted as urgent or expedited must meet the CMS definition of an expedited request and be supported by clinical documentation demonstrating the urgent need.
CMS defines an expedited/urgent request as:
“A request for a determination in which waiting for a decision under the standard timeframe could place the member's life, health, or ability to regain maximum function in serious jeopardy.”
Providers are encouraged to carefully assess the clinical circumstances and submit all relevant supporting documentation at the initial submission to avoid delays in processing.
Medicare Advantage requirement: Type 2 (organization/business) National Provider Identifier
Providers submitting claims for Medicare Advantage members must have a Type 2 National Provider Identifier (NPI) on file for their business. Federal law requires all healthcare providers and organizations use a standard identifier in their administrative and financial transactions.
All electronic claims submitted to Delta Dental must include:
- Treating dentist’s Type 1 NPI
- Treating dentist’s state license number
- Tax Identification Number (TIN) of the billing dentist or practice
- Type 2 NPI to identify the billing provider, following these guidelines:
- Multiple dentists at one practice location (group practice, partnership): Type 1 for each dentist and Type 2 for the practice, if claims are transmitted in the practice’s name and TIN.
- Multiple dentists at multiple practices (clinics, dental service organizations, etc.): Type 1 for each dentist and Type 2 for each practice, with a separate TIN.
To register for a Type 2 Billing NPI, please go to the NPI registry. For step-by-step registration instructions, please refer to our guide. Delta Dental does not have access to your application status.
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