A: Our online ‘Check Patient Benefits’ tool provides a comprehensive overview of your patients’ benefits and eligibility, including:

• Membership status
• Member ID (MID)
• Copay percentages
• Service and usage coverage
• Treatment waiting periods
• Procedure code lookup
• Patient treatment history lookup, including site specific procedures
• Treatment eligibility (like additional cleanings)
• Dependent age limit/eligibility (including orthodontics)
• In-network, out of network, and out of area status
• Clinical guidelines and documentation requirements
• Code/contract limitations

To access our ‘Check Patient Benefits’ tool:

1. Log into your Provider Portal account at DeltaDentalWA.com/Provider
2. Find the green rectangle labeled ‘Check Patient Benefits’ in the top left corner
3. Click “Search for Patient.” You can choose between “Search by Patient Details” or “Search by Subscriber ID” in the narrow green rectangle.
4. Click your patient’s name to access their Benefits and Eligibility page

A: You can verify if the procedure you want to perform is allowable on the same day or if it will cross check with any other procedure in our Processing Policy Manual, or by submitting a Confirmation of Treatment and Cost.

To view our Processing Policy Manual (updated annually):

Option 1

1. From your patient’s Benefits and Eligibility page (instructions above, under ‘Check Patient Benefits’ tool), scroll down to ‘Check Patient Eligibility Details’
2. Click ‘2023 Processing Policy’ (or current year)

Option 2

1. Log on to your Provider Portal account at DeltaDentalWA.com/Provider
2. Hover over ‘Library’ (at the top of the page)
3. Click ‘Manuals’
4. Click ‘2023 Delta Dental of Washington Processing Policy Manual’ (or current year) to view each code listed with general guidelines.

A: Yes, most plans provide an (O), or out of network coverage. However, there are plans that are strict (I), in-network plans only. Meaning there is no (O), or out of network coverages. Medicare Advantage plans, such as KPMA, are a few of our groups that provide no coverage for out of network treatment. Plans that do not have out of network coverage will show NA in the coverage section in their benefit overview.

A: There are two ways to find the Allowed amount. We recommend submitting a Confirmation of Treatment and Cost (COTC) to determine the allowed amount and what the plan will cover, which is valid for 180 days. You can also reach out to your home state Delta Dental to verify your allowed fees.

A: To verify if a member has other coverage, log into your Provider Portal account at DeltaDentalWA.com/Provider and click the green chat icon in the bottom right corner.

A: The chat will start with a virtual agent (AI robot) for frequent questions and will connect you with a live agent if needed to answer your specific questions.

A: We’re happy to help you with additional questions. To chat with a live representative, visit DeltaDentalWA.com/Provider and click on the green chat icon in the bottom right corner of the page to start the conversation.