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FAQs - Provider | Delta Dental of Washington

The following are commonly asked questions by our dentists

Online account questions

How do I change the email preferences, including the email address I provided, upon initial registration on your website?

To change your email preferences you will want to follow these steps. Log on to your account at DeltaDentalWA.com. On the upper right hand corner of the screen, select My Preferences. Once you click on this button, you will be able to update your email address, paperless options and update other items you would like to receive via email.

How do I change the password on the account I created?

To change your password, please sign-in to your account at DeltaDentalWA.com. On the upper, right hand corner of the screen select Change Password. Enter your current password and the new password you would like to update on your account.

How do I update the security question for the account I created on your website?

To change your security question please follow these steps. Log on to your account at www.DeltaDentalWA.com. On the upper right hand corner of the screen, select My Preferences. Once you click on this button, the link name will change to “Edit Profile.” Please click on the Edit Profile link. You will now be able to update the security question you provided upon initial registration.

Benefits and Eligibility

How can we obtain benefit information for our patients without waiting on the phone?

There are two easy-to-use options available:

  • Our interactive voice response (IVR) system allows you to use your touch-tone phone to obtain eligibility and benefit information, and claim status. You'll also be able to elect to have the benefits said back to you, by choosing the speak back option. Our IVR also includes the ability to have the information you request faxed directly to your office for eligibility and benefit information, claim status or the status of unpaid claims we've received within the past 60 days. The IVR flow chart can be found by clicking here.
  • You can also go to the secured section of our website and check patient benefits, claim status and verify the amount of your payment voucher.

My benefits page is not printing correctly, how do I get everything on the page to display when printing?

To view all benefits, change your print preferences to landscape. This allows all of the information to fit on the page.

The Interactive Voiced Response System (IVR) states that there is an Eligibility through Date of 06/30/2014, what does this mean?

The eligibility through date on the fax back indicates the system is able to confirm eligibility and benefits through the end of the month. If the individual you are inquiring about has not had any coverage/employment changes after the end of the month, they will still be eligible for coverage.

Is there a missing tooth clause?

No, we don't have a missing tooth clause.

Can all four quadrants be done on the same day for procedure code D4341?

No, no more than two quadrants can be done on the same day.

Claims

What is the claims mailing address?

Our claims mailing address is:

Delta Dental of Washington
P.O. Box 75983
Seattle, WA 98175

What if there's additional information I feel is pertinent to processing a specific claim?

If you believe there is additional information that should have been considered in the processing of a claim or Confirmation of Treatment and Cost (also called a predetermination), you may place one of the following “key words” along with the additional information in the comment field of the claim form. These “key words” will stop a claim for review of additional information.

  • Accident
  • Appeal
  • Corrected
  • Reconsider
  • Reevaluate
  • Reprocess
  • Resubmission
  • Review
  • Seat

Does Delta Dental pay on the prep or seat date for a crown?

Provider contracts and contracted benefit plans require payment to be made based on completed treatment. Please submit claims using the date treatment is completed.

When do we need to submit x-rays?

Click here for our current documentation requirements.

What is the process of submitting Orthodontia claims?

When submitting a full case set-up, it is not necessary to submit claims for monthly or quarterly payments. In fact, it is important that you do NOT send continuation claims for the remainder of treatment. Delta Dental will set those up automatically and pay them on schedule. If you are not receiving payments, call Delta Dental Customer Service at (206) 522-2300 or 1-800-554-1907. When submitting your full case set-up claim, please be sure to include:

  • The banding date
  • The total treatment fee
  • The down payment
  • The estimated number of treatment months (not payment months)
  • The monthly fee

Where can I periodically review information about the Clinical Review process at Delta Dental?

Clinical review information is available by selecting the Clinical Information drop down in the menu, after you login to your account.

If I submitted incorrect information on a claim, what is the best way to submit a corrected claim so I don’t have to call customer service?

If you need to submit a corrected claim, please make sure you clearly indicate on a new claim form that it is a corrected claim and include a narrative with the corrected information. (For example: Claim #123456789123456 submitted with tooth #15 in error. Please reprocess D7140 using tooth #16.) If the additional or corrected information is not submitted with a corrected claim form, it will be returned to your office.

If my patient has Dual Delta Dental Coverage do I need to submit two claim forms?

No, only one claim needs to be submitted as long as all the Secondary Coverage information is filled out under the other coverage section of the claim form.

Should I highlight important information on claim forms before sending them in?

Highlighting data on the claim forms causes that information to be unreadable when the claims are scanned. Please do not highlight any information on them prior to submitting them.

How long should I wait to receive payment or denial on a claim before I resubmit the claim or contact customer service?

Delta Dental has 30 days to process claims. For claims that have not received a payment or denial, please wait 30 days before resubmitting them or calling customer service to inquire about their status. Resubmitting the claims may cause additional claim volume and can delay the payment or denial of the claims.

Are there any restrictions to sealants?

Sealants are covered on permanent molars with no restorations or decay on the occlusal surface.

Should I include the primary carrier’s explanation of benefits (EOB) when submitting a claim to Delta Dental if Delta Dental is the secondary carrier?

Yes. You should always include the primary carrier’s EOB when submitting your patients’ claims to us if we are secondary. This will reduce requests for additional information and help ensure that your claims are processed quickly and accurately.

Medically Necessary Orthodontic Treatment

What is considered "medically necessary" orthodontia?

The Medical Necessity Standard defines “medical necessity” as medical conditions listed on the Delta Dental Orthodontic Form for Medical Necessity or uses as a guide the Washington Modified Handicapping Labiolingual Deviation (HLD) Index Score that result in a score of 25 or higher. Delta Dental Orthodontic Form for Medical Necessity

Delta Dental of Washington reviews all requests for treatment for conditions that result in a score of less than 25 on a case by case basis with consideration of medical necessity.

What are the medical conditions listed on the Delta Dental Orthodontic Form?

  • Cleft lip and palate, cleft palate, or cleft lip with alveolar process involvement, or
  • The following craniofacial anomalies: Hemifacial microsomia, Craniosynostosis syndromes, Cleidocranial dental dysplasia, Arthrogryposis, Marfan syndrome
  • Medical conditions as indicated on the Washington Modified Handicapping Labiolingual Deviation (HLD) Index Score that result in a score of 25 or higher.

Where can I find the Delta Dental Orthodontic Form for Medical Necessity?

The form is available under the Resource tab, within the forms page 'Delta Dental Orthodontic Medical Necessity."

What supporting documentation is required to assist in determining Orthodontia Medical Necessity?

Documentation requirements include the Delta Dental Orthodontic Form for Medical Necessity and a full series of orthodontic photographs (includes three extraoral and five intraoral, including occlusal views).

What is the best way to submit the required supporting documentation for Medically Necessary Orthodontia?

The Delta Dental Orthodontic Form for Medical Necessity and the full series of orthodontic photographs should be submitted electronically via Fast Attach services provided by National Electronic Attachments (NEA).

Does Medically Necessary Orthodontia require preauthorization or confirmation of treatment and cost (also called a predetermination)?

Preauthorization is required for medical necessity determination.

Confirmation of Treatment and Costs (also called a predetermination) may be required for non-medically necessary orthodontics. Please check the plan specific requirements.

Membership

If I am a Delta Dental member dentist, which networks do I belong to?

When you become a member dentist with Delta Dental, you are automatically a member of the Delta Dental Premier® network. You must apply separately for any other network(s) you would like to join. If you're not sure which networks you have joined, you can use the "Find a Dentist" capability on our website to double check. Click the Refer a patient link under Provider Tools and search for yourself; the results will display every network you currently belong to.

I am a member at one dental office. Does that mean I'm automatically a member at all of my offices?

No. Delta Dental membership, and membership in any provider network, is per location. If you want to be a member dentist in any or all of our networks at multiple locations, you must apply separately for each location.

Do dental associates working under my Tax ID Number need to be members?

No. Your employees do not need to be member dentists, but this could result in their claims paying as non-member claims, using non-member fees. This is especially true for claims processed in states other than Washington. Also, most Delta Dental plans pay non-member claims directly to the patient instead of to the dentist.

Can I access membership applications online?

Yes. You can access the Delta Dental Premier® application online, they're found under the Resource tab within the forms page.

After completing your application, you can fax it to (800) 460-3159 for fastest processing. If you don't wish to fax your documents you can mail them to:

Delta Dental of Washington
P.O. Box 75983
Seattle, WA 98175

The PPO application is available online. Simply login to your account, select Provider Contracts and PPO Provider Agreement. You can also obtain a copy by contacting our Provider Services team at (800)238-3439.

I am changing or have changed my Tax ID Number. What's next?

Please complete a Tax Identification Change Notification form and fax them to Provider Services at (800)460-3189. The form is located under the Resources tab, on the forms page.

Fees

Can a Customer Service representative give me my filed fees?

No. Our Customer Service representatives can only verify a filed fee if they are researching a fee for a procedure your office has submitted to verify whether the correct fee was applied by our computer information system. If you are a Delta Dental participating dentist and would like a complete listing of your filed fees, you can contact our Provider Services team at 1-800-238-3439 or 206-528-7394.

What is a Maximum Allowable Fee?

In the absence of a filed fee for a specific procedure code, the benefit determination (payment) is based on the established maximum allowable fee.

Can you tell me Delta Dental's Maximum Allowable Fees over the phone?

Our Provider Services representatives can tell you the maximum allowable fee for procedures you cannot file fees for. You can get the maximum allowable fee for up to three procedures over the phone. Member dentists can also view them through our Fee Filing application after logging into the secured section of our website

There are several dentists in our office with the same fees. Can we update all of their fees at the same time?

You cannot update the fees for multiple providers at one time. The fees must be updated for each provider individually. If you get any kind of error when doing so, please call Provider Services at 1-800-238-3439.

General Questions

How can I get my question answered if I don't have time to hold on the phone?

If you need the answer to a simple question and you don't see it in these FAQ's, you can e-mail us at ProviderServices@DeltaDentalWA.com and we'll respond to your question within one business day.

I tried to login with my other account but the website is stating I am still logged in as my other account, what do I do?

You are still logged in with the your other account because you did not log out from your prior session. Internet Explorer 8 and higher keeps your session cookie and automatically logs you back in to your original account. To access a new session, go to File in the upper navigation bar and choose New Session from the drop down options. This will open up a new window and you will be able to log in with your different account.

What is Delta Dental of Washington Payer ID?

91062

Where can I review the Delta Dental processing policies?

The Delta Dental Processing Policy Manual is available to member dentists and is located in the Provider Library section of our website, Manuals.

My office is interested in new products and procedures, what are the DDPA guidelines for covering such treatment?

To be considered for coverage, new products and procedures must be proven and accepted as valid and effective based on the body of scientific evidence of effectiveness as reported in high quality refereed scientific literature. To learn more about the DDPA guidelines for New Dental Product and Technology Adoption Guidelines, visit the clinical criteria requirements page, which is located in the clinical information tab.

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