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Frequently Asked Member Questions
- Common Member Questions
- What is a dental plan?
- Do I need my identification (ID) card when I get care?
- What if someone in my family has another dental insurance plan?
- What is an Explanation of Benefits (EOB)?
- Can I change dentists?
- How do I know which dentist to select?
- Do I need to verify that my dentist is a Delta Dental participating dentist?
- What are the advantages of using a Delta Dental participating dentist?
- Can I see an out-of-network dentist?
- What username should I use when signing into the system?
- How are dental benefits affected if my dependent child is ill or injured and can no longer attend school on a full-time basis?
What is a dental plan?
Understanding your dental benefits can help you receive appropriate and cost-effective care. Our easy-to-read brochure will provide you with a clearer understanding of this important benefit. [Return]
Do I need my identification (ID) card when I get care?
If you have an ID card, show it to your dentist at each visit so a proper claim can be filed for your dental services. Otherwise, supply your group name, group number (if you know it) and your ID number/Social Security number. To find a participating dentist, please visit our Find a Dentist tool. [Return]
What if someone in my family has another dental insurance plan? How does Coordination of Benefits (COB) work?
When someone has additional dental coverage, one plan is usually primary. Your dentist will send the claim for service to the primary insurance plan and may also submit it to a secondary plan. In this case, Delta Dental will coordinate benefits. Refer to your benefit booklet for your plan’s specific provisions. [Return]
What is an Explanation of Benefits (EOB)?
This is a document you receive from Delta Dental after you visit the dentist. It is not a bill, but rather an explanation of what procedures were performed and what was covered by your dental plan. Though EOBs vary across Delta Dental member companies, they should include the dentist's fee, the portion Delta Dental paid and any amount you may owe (such as deductible, coinsurance or non-covered services). It should also include an update on how much of your annual maximum has been used and the amount you've paid toward your deductible.[Return]
Can I change dentists?
Yes. Requirements for changing dentists vary by plan; refer to your benefit booklet for your plan’s specific provisions. [Return]
How do I know which dentist to select?
Ask friends, neighbors, co-workers and family to find a dentist who matches your needs and values. A convenient location and clinic hours, possibly including Saturday and evening hours, may also be important considerations. [Return]
Do I need to verify that my dentist is a Delta Dental participating dentist?
Yes. By checking with your dentist or Delta Dental Customer Service (see the back of your ID card for the phone number), you are assured that your dentist is participating in one of our networks. Consult your benefit booklet for more information regarding your specific plan design. We suggest you verify a dentist’s participation status with Delta Dental or your dental office before each appointment. [Return]
What are the advantages of using a Delta Dental participating dentist?
A Delta Dental participating dentist has signed a participating and membership agreement with Delta Dental. The dentist has agreed to accept our allowable charge as payment in full for covered dental care. A participating dentist is not allowed to bill more than our allowable charge. A Delta Dental participating dentist will also file the claim directly with us. We will make payment directly to the participating dentist and you will receive an explanation of benefits detailing your financial responsibility for any deductible or coinsurance amounts. [Return]
Can I see an out-of-network dentist?
Yes, you may seek services from a non-participating (out-of-network) dentist: Reimbursement for the services will be paid directly to you, and you are responsible for paying your dentist. A non-participating dentist does not have a requirement to accept our allowable charge so you may share in more of the cost for your care. You are responsible for paying your dentist up to the dentist’s full-billed amount. [Return]
What username should I use when signing into the system?
Use the username you created during the registration process. Note, the username field is separate from the subscriber ID field, which uses your subscriber ID or Social Security number. [Return]
How are dental benefits affected if my dependent child is ill or injured and can no longer attend school on a full-time basis?
Under Michelle’s Law, if an unmarried dependent child who was attending a postsecondary educational institution on a full-time basis and is currently covered under the parent’s dental benefit policy becomes seriously ill or is injured, he/she may continue to be covered. In order to remain covered, a physician must provide written documentation supporting the need for a medical leave.
For details, access:
Michelle’s Law Disabled Dependent/Michelle’s Law Application [Return]
Frequently Asked Questions by Employers
- Common Employer Questions
- Who is Delta Dental Connect SM?
- What constitutes an eligible employee for dental coverage with Delta Dental’s smaller employer plans?
- As a new benefits administrator, what materials and acknowledgment can I expect?
- What sections on the enrollment form must be filled out?
- Does Delta Dental have a minimum premium contribution required by employers to set up a dental plan?
- How are dental benefits affected if a dependent child is ill or injured and can no longer attend school on a full-time basis?
Who is Delta Dental ConnectSM?
Delta Dental Connect is an experienced group of sales and service representatives dedicated to responding to the questions of our brokers and small group administrators (2-100 employees).
Delta Dental Connect services include:
- Rate and product information
- New group implementation
- On-site information/education sessions
- Sales and requests for proposal
- Post-sale service/account management
Contact us at 1-866-280-8367 or DeltaDentalConnect@DeltaDentalNE.org. For individually rated groups of 100 or more employees, please contact Sales and Marketing at 612-360-0412. [Return]
What constitutes an eligible employee for dental coverage with Delta Dental’s smaller employer plans?
Full-time employees working a minimum of 20 hours per week or subject to the employer’s practice (if greater than 20 hours per week) are eligible. Seasonal or temporary employees are usually not eligible. [Return]
As a new benefits administrator, what materials and acknowledgment can I expect?
The benefits administrator for our new customers receives:
- Welcome letter
- Group contract
- Administration manual
- Identification card and summary plan booklet for each employee
If a broker is associated with the new group, he/she also receives a copy of the welcome letter and contract. [Return]
What sections on the enrollment form must be filled out?
The benefits administrator and/or broker is responsible for ensuring the employee sections of the enrollment form are complete and accurate for each enrolled employee. The employee’s signature is required.
The section labeled “Other Insurance Coverage” should be completed as accurately as possible, as Delta Dental uses this information to determine group participation. If an employee waives all coverage, or is married and wants employee-only coverage, information on whether or not the employee’s dependents have coverage and if so, the name of their carrier, must be provided.
The “Group Enrollment Information” section at the bottom of the form must also be completed. [Return]
Does Delta Dental have a minimum premium contribution required by employers to set up a dental plan?
Delta Dental no longer has a minimum premium contribution requirement. If the participation and underwriting requirements are met, the group will be approved for coverage. Group plans that have less than 50 percent employer premium contribution are typically considered to be voluntary. [Return]
How are dental benefits affected if a dependent child is ill or injured and can no longer attend school on a full-time basis?
Under Michelle’s Law, if an unmarried dependent child who was attending a postsecondary educational institution on a full-time basis and is currently covered under the parent’s dental benefit policy becomes seriously ill or is injured, he/she may continue to be covered. In order to remain covered, a physician must provide written documentation supporting the need for a medical leave. For details, access:
Michelle’s Law Disabled Dependent/Michelle’s Law Application
- Please select the option which best suites your question:
- General Provider Questions
- Claims history on the Website
- Remittance Advice
- NPI Related Questions
Frequently Asked Provider Questions - General
- Common Provider Questions
- Who is eligible to become a Delta Dental participating dentist?
- What is the purpose of a Participating Dentist Agreement?
- How does Delta Dental determine the dentist’s reimbursement level?
- Does Delta Dental require credentialing?
- I’m interested. How do I contact Delta Dental?
- How should I submit procedures that are being done for cosmetic purposes?
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.
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?
Procedures that are not covered, such as cosmetic procedures, should not be submitted to Delta Dental. If a patient requests or requires a denied Estimate of Benefits for a secondary carrier or a flex plan, please send the pre-estimate directly to our Professional Review Department with a note stating that the procedure is not covered or is being done for cosmetic purposes and the patient needs a denial.
Delta Dental of Minnesota Attn: Professional Review Department
PO Box 9120
Farmington Hills, MI 48333-9120 [Return]
Frequently Asked Provider Questions - Claims
- Common Provider Claims Questions
- Where can I find claims history information on the Delta Dental website?
- Some employers provide more detailed information than others. Why?
- Where can I find the dates a patient is eligible for benefits for a procedure?
- Where is the patient’s address displayed on the website?
- Where is the claims processing address displayed on the website?
- Is waiting period information available on the website?
- Is a listing of reason denial codes available on the Website?
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?
Is a listing of reason denial codes available on the website?
Not at this time.
Frequently Asked Questions - Remittance Advice
- The following questions relate to 835/Electronic Remittance Advice.
- What is an 835/Electronic Remittance Advice (ERA)?
- How will I receive the 835/ERA?
- How will this be loaded into my Practice Management System?
- Will I be charged for the 835/ERA?
- Can I still receive paper?
- Will the 835/ERA differ from paper?
- Can I discontinue the paper EOBs I receive?
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?
No, you can not. [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. Follow the instructions provided in the Dental Office Toolkit to request this. [Return]
Frequently Asked Provider Questions - NPI
- National Provider Identifier Questions
- What are the advantages of the NPI?
- How is my NPI determined?
- Who is required to apply for an NPI?
- Will the NPI replace other numbers I use?
- How do I apply for my NPI?
- What do I do with my NPI once I have it?
- Where can I go for additional help and information? [Return]
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
Other "legacy" identification numbers
The NPI will not replace numbers used for purposes other than general identification, such as your:
Social Security Number
Taxpayer ID 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]
Agent Appointment Application
This application is for brokers interested in applying to sell Delta Dental insurance.
To complete this online application, be ready to provide the following information:
- Personal information, including SSN
- Agency information, including Federal Tax ID and business licenses.
- Broker license information for both your resident state and the state you wish to be appointed in.
- Checking account information for Direct Deposit setup.