Dear providers:
We’re reimagining our occasional newsletter to make it a monthly must-read full of policy updates and practical tips. Watch for this monthly communication designed to help you stay informed, save time and focus on patient care.
Submit claims through DOT or your clearinghouse
For members enrolled in adult Medicaid and Healthy Michigan Plan, Medicare Advantage, Healthy Kids Dental or Michigan Coordinated Health, dental claims should be submitted directly to Delta Dental or your clearinghouse using payer ID DDPMI. Claims submitted with the incorrect payer ID will result in denials.
Please do not submit claims to the health plan the member is enrolled in.
Pre-service and post-service claims can be submitted through any of the following:
- Directly through Dental Office ToolkitTM (DOT)
- Transmitted through a clearinghouse
- Post-service only: Sent through the mail to Delta Dental Government Programs (P.O. Box 9298, Farmington Hills, MI 48333-9298)
Code D2940
Effective June 1, Delta Dental of Michigan requires the inclusion of the applicable tooth number and surface(s) for Code D2940 when submitting claims. This aligns with expectations of both the Michigan Department of Health and Human Services and the ADA. If both the tooth number and surface(s) are not submitted for Code D2940, the claim will be denied.
For more information, please refer to Appendix 3: ADA Guide to Dental Procedures Reported with Area of the Oral Cavity or Tooth Anatomy (or Both).
New provider wait time standard
The Centers for Medicare and Medicaid Services has adopted a new provider wait time standard to ensure that new or existing patients who obtained dental coverage through the federal exchange can obtain a dental appointment with any in-network Delta Dental PPO™ or Delta Dental Premier® dentist (including specialists) within 30 business days of the patient requesting an appointment from the office. If you need help meeting this standard, please call your professional services representative.
The National Medicaid Collaborative
Delta Dental of Michigan, in partnership with at least 16 other Delta Dental member companies around the country, has launched the National Medicaid Collaborative to better meet our mission of improving oral health for underserved populations.
“We’re really focused on improving access and utilization for the most vulnerable populations: Rural areas, children with intellectual and development disabilities (IDD), pregnant women, low-income areas and foster care,” said Kush Shaqiri, senior vice president of Government Programs. “That’s where we’re really going to prove the value, because politically, there’s always going to be different opinions, but I think there’s universally an understanding that these populations really need to continue to maintain strong oral health and access to care.”
Our refreshed website
We’ve revamped deltadentalmi.com! The new website better supports our members, providers, benefit managers and producers through improved usability, navigation and content organization. Based on user feedback and changing needs, we may make refinements and adjustments to ensure the site continues to serve you efficiently.
Next issue of Best Practice magazine
The next issue of Best Practice magazine will be published this summer. The theme, “Access into Action,” will showcase stories about how access to resources leads to real use and benefits for members and providers.
Reminder: Appointment timeliness
If you are scheduling patients who have Healthy Kids Dental, Healthy Michigan Plan or MI Health Link benefits, remember that they must be seen or scheduled within a set time frame. These benchmarks are based on treatment urgency and are required by the Michigan Department of Health and Human Services. Find these benchmarks in your participation contract or below for general practitioners or pediatric dentists:
- Urgent care—see within 48 hours
- Routine services—schedule within 21 business days
- Preventive services—schedule within six weeks
- Initial appointment—schedule within eight weeks
- Emergency services—provider must be available immediately, 24/7
Emergency dental care
Unscheduled dental services necessary to treat a life-threatening condition in the mouth or face include services to address uncontrolled bleeding, spreading infection, severe debilitating pain or traumatic injury to the mouth or face.
Retrospective review of codes normally requiring prior authorization may be submitted for review when urgent or emergency care is justified. Please remember to include a remark indicating ‘emergent’ or ‘emergency’ in the remarks box when submitting these types of claims.