Providers:
Check out our monthly must-read designed to help you stay informed, save time and focus on patient care.
Cracking the code: D2952 cores
Cores, or creating an artificial foundation for a crown, should not be reported when the procedure only involves a filler to eliminate any undercut, box form or concave irregularity in the preparation (D2949).
Additionally, cores aren’t payable with inlays and ¾ crowns, nor payable with post, core or crown (D2952).
Reminder: Clinical criteria information
It is our policy to adopt objective and evidence-based written clinical criteria to be referenced as guidelines when the administration of member dental plans requires professional determination of the medical necessity or clinical appropriateness of dental services.
Visit our “Clinical Criteria” page to find:
- Clinical criteria for utilization review determinations (adults)
- Clinical criteria for utilization review determinations (children)
- Clinical criteria documentation (by procedure)
Enroll in National EFT
Selecting National EFT as your direct deposit payment method means you can receive direct deposit payments from Delta Dental member companies nationwide and ensures faster reimbursement. Providers who participate in National EFT will have access within their Dental Office Toolkit™ (DOT) account to view EFTs and EOBs for:
- Delta Dental of Arizona, Delta Dental of Indiana, Delta Dental of Michigan, Delta Dental of Minnesota, Delta Dental of Nebraska, Delta Dental of New Mexico, Delta Dental of North Carolina, Delta Dental of Ohio and Delta Dental of Tennessee
- CMS ONLY—Delta Dental of Illinois, Delta Dental of South Dakota, Delta Dental of Virginia and Delta Dental of Wisconsin
Special Healthcare Needs Benefit
Dental care is among the top unmet health needs for adults with intellectual and developmental disabilities. Delta Dental’s Special Healthcare Needs Benefit reduces barriers to care by providing eligible members with enhanced benefits, including additional dental visits, additional cleanings and treatment delivery modifications.
We offer opportunities to increase utilization of these services. Check a patient’s eligibility in DOT and sign up for our online continuing education course to learn more.
Medicaid: Notice of non-covered services consent form
Delta Dental does not pay for non-covered services. If a member chooses to undergo a non-covered service, the member must fill out and sign a notice of non-covered services consent form on the date treatment is performed. Access this form here.
Emergency and post-stabilization services
Emergency dental care and post-stabilization services are reimbursable and do not require prior approval. Emergency dental care is considered unscheduled dental services necessary to treat a life-threatening condition in the mouth or face that occurs suddenly and requires immediate care in the dental office or emergency room, such as uncontrolled bleeding, severe spreading infection, severe debilitating pain or severe traumatic injury to the mouth or face.
For more information, refer to sections 2 and 7 of your provider manual on DOT.
Mailing address change: Delta Dental of Missouri, Delta Dental of South Carolina
Effective Aug. 1: Providers who treat Delta Dental of Missouri and/or Delta Dental of South Carolina members and need to submit paper claims and pre-treatment estimates can do so to the following address.
Delta Dental of Missouri
PO Box 70210
London, KY 40742
To avoid payment delays, we strongly encourage providers to enroll in National EFT through DOT.
Do you know your provider representative?
Check out the map and reach out today!
Counties by representative
- Benton
- Boone
- Brown
- Carroll
- Cass
- Clay
- Clinton
- Crawford
- Daviess
- Dubios
- Fountain
- Fulton
- Gibson
- Greene
- Hendricks
- Jasper
- Johnson
- Knox
- La Porte
- Lake
- Lawrence
- Marshall
- Martin
- Monroe
- Montgomery
- Morgan
- Newton
- Orange
- Owen
- Parke
- Perry
- Pike
- Porter
- Posey
- Pulaski
- Putnam
- St. Joseph
- Starke
- Spencer
- Sullivan
- Tippecanoe
- Vanderburgh
- Vermillion
- Vigo
- Warren
- Warrick
- White
- Adams
- Allen
- Bartholomew
- Blackford
- Clark
- Dearborn
- Decatur
- Delaware
- DeKalb
- Elkhart
- Fayette
- Floyd
- Franklin
- Grant
- Hamilton
- Hancock
- Harrison
- Henry
- Howard
- Huntington
- Jackson
- Jay
- Jefferson
- Jennings
- Kosciusko
- LaGrange
- Madison
- Marion
- Miami
- Noble
- Ohio
- Ripley
- Rush
- Scott
- Shelby
- Steuben
- Switzerland
- Tipton
- Union
- Wabash
- Washington
- Wayne
- Wells
- Whitley