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2. What is the purpose of a Participating Dentist Agreement?
3. How does Delta Dental determine the dentist's reimbursement level?
4. Does Delta Dental require credentialing?
5. I'm interested. How do I contact Delta Dental?
1. 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 of Nebraska participating dentist.
2. 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 file claims for your Delta Dental patients and report your usual fees on a confidential basis.
- 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 update Delta Dental's Professional Services area with your most current dental practice information (i.e. credentialing information) at least once every four years.
The usual fees of each participating dentist are filed confidentially with Delta Dental of Nebraska. Delta Dental pays participating dentists the appropriate percentage of the usual fees, or the fees actually charged, whichever is less, subject to fee table maximums. Payment of the dental plan's obligation is made directly to the participating dentist. Delta Dental of Nebraska participating dentists accept this reimbursement as payment in full for services covered under the plan. This fee table is not published; however, a Delta Dental Network Representative can assist dentists in determining how their filed fees compare to the maximum allowable amount paid by Delta Dental.
4. 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 of Nebraska has a formalized credentialing process through which we objectively evaluate dentists against formalized standards.
5. I'm interested. How do I contact Delta Dental?
To speak with a Network Services Representative about network participation, call 800-328-1188 Ext. 4170.
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