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06/16/2014

CDA informs members of new Delta Dental provider agreement


CDA learned in late May that Delta Dental of California began distributing a new Participating Provider Agreement (Commercial Fee-for-Service) to newly contracting California providers.

For those newly contracting providers, this new agreement appears to be an all-inclusive provider agreement for both the Delta Dental Premier and PPO products. CDA understands that Delta Dental will no longer offer separate Premier and PPO provider agreements to newly contracting dentists. Along with the new Provider Agreement, newly contracting dentists will receive the Delta Dental Premier Addendum, which includes the Provider’s List of Proposed Fees (Premier fee schedule), and some dentists may also receive the Delta Dental PPO Schedule of Allowances.

See Figure 1. for a breakdown of the various provider types and how dentists may or may not be impacted by the new Delta agreement and fee schedules.

Figure 1.

Provider Type

Impacted by New Delta Contract?

Delta Premier Fee Addendum

Delta Dental PPO Fee Schedule

Existing Delta Dental Contracted Providers

Only if opening an additional practice location.

Associates joining existing practices will be impacted by the new contract as noted in the boxes below.

This document replaces the “Confidential Fee Filing Form” previously used for submitting annual fee updates. Existing Delta providers will utilize this form for future annual fee updates.

New contract is not applicable to currently contracted Delta providers.

Newly contracting General Dentists, Prosthodontists, Orthodontists* and Pediatric Dentists

Yes, will need to sign in order to become a Delta provider.

Will be paid Premier fees when treating Premier patients.

Will be paid PPO fees when treating PPO patients.
(*Ortho is paid on a separate fee schedule.)

Newly contracting Endodontists, Periodontists and Oral Surgeons.

Yes, will need to sign in order to become a Delta provider.

Will be paid Premier fees on all Delta patients.

N/A


Dentists joining a practice as an associate may need to sign this new agreement in order to become a participating provider of Delta Dental of California.

The impact of signing this agreement should be carefully considered for practices with more than one Delta participating provider, as it may be confusing to patients if dentists within the same practice participate in different Delta provider networks.

The revised Delta agreement is similar to Delta Dental’s Participating Provider Agreement for the Delta Dental PPO dated June 2010 (distributed 2010 through May 2014). Differences in the new provider agreement versus the previous Delta Dental PPO and Premier agreements can be found in Figure 2.

Figure 2.

Comparison of Contract Provisions

Former Delta Premier and PPO agreements

New Delta Dental Commercial Agreement

Prosthodontists and Orthodontists

Not required to sign the PPO agreement.

Required to participate in the Premier and PPO programs.

Termination

Provider could terminate agreements separately (with required notice) and there was no minimum amount of time dentist had to be under the contract prior to termination.

Dentist must remain as a contracted provider for one year prior to termination.

Payment of Claims

Under the former PPO agreement, Delta would pay based on the lesser amount of the Accepted fee (Premier contracted amount)/PPO contracted fee or the submitted fee.

Delta will pay claims based on the enrollee/patients’ plan type (Premier rates paid for Premier enrollees, PPO rates paid for PPO enrollees).


CDA reached out to Delta Dental of California representatives for additional clarification on the above information. CDA, however, did not receive a response before this article went to press.

CDA recognizes that participating as a contracted plan provider for any dental plan is a decision that can only be made by individual dentists based on what is best for their patients and their practices. In order to assess the impact of the contract and accompanying reimbursement rates, CDA recommends utilizing the following services and/or resources when considering participating as a provider with any dental plan.

Contract Analysis Benefit

The Contract Analysis Benefit is a free service available to all CDA/ADA members. This service includes ADA legal review of contracts from managed care companies and discount benefit programs. While the analysis isn’t personalized for each dentist, it will inform dentists in clear language about the provisions of the contracts and point out any potential implications of provider participation. Submission of a clean, unsigned copy of the agreement is required. Turnaround time for receiving the analysis varies.

Evaluating Dental Benefit Plans Checklist

Available on cda.org, this two-part checklist is divided into two sections to assist with evaluating “new dental benefit plans” and “existing dental benefit plans.” This resource helps member dentists evaluate the potential implications of the dental plan relationship on their practices by reviewing a list of questions and raises items of consideration.

Dental Benefit Plan Production Calculator

This Excel calculator has been created to evaluate the return on investment for new or current dental benefit plans dentists are considering for their practices. This resource can be found at cda.org and it is best used in conjunction with the Evaluating Dental Benefit Plans Checklist (mentioned above).

For more information regarding the above-referenced CDA resources, visit cda.org/practicesupport.