Delta Dental of California is revising its Delta Dental of California Participating Provider Agreement effective June 1, 2022. Although described as an “enhancement,” the contract amendment alters reimbursement for Premier or PPO contracted dentists who treat DeltaCare® enrollees (Delta’s closed network HMO product) as out-of-network providers.
The contractual amendment revises the reimbursement from the dentists’ submitted fees to the lesser of submitted, Premier and PPO fees. The amendment does not reduce existing approved fees for Premier or PPO dentists. It will only affect reimbursements for DeltaCare® enrollees treated by Premier/PPO providers.
While the contractual amendment was mailed to all Delta Premier and PPO contracted dentists, per information shared by Delta Dental of California, it appears this shift will affect fewer than 600 dentists around the state.
How the amendment impacts you
If you previously treated a DeltaCare® enrollee, you were paid according to your submitted charges. Under this policy change effective June 1, 2022, you will be paid the lesser of your Premier or PPO contracted fee or your submitted fee. This change will be reflected in the Potential Financial Impact statement provided by Delta Dental with the notice. As stated above, this amendment does not affect your existing Premier or PPO fees.
If there isn’t a DeltaCare® provider in the enrollee’s area, Delta Dental Premier and PPO contracted providers will continue to have the option to treat DeltaCare® USA enrollees, but only upon preauthorization by Delta. As a Delta Premier or PPO contracted dentist, you may be contacted by a Delta Dental customer service representative and offered the opportunity to treat DeltaCare® enrollees.
What you need to do
Review the documents sent by Delta Dental of California (letter, amended agreement, financial impact statement and Q&A), along with the accompanying elements you’ll find in the Delta Dental provider portal.
Read the Potential Financial Impact statement provided with the notice. Most of these statements will reflect $0 impact as this change affects fewer than 600 dentists in California and applies only to DeltaCare® enrollees.
Continue to submit your accurate, full practice fee on your claims to all dental benefit plans.
If a DeltaCare® USA member contacts your office for treatment and you are not in the DeltaCare® USA network, refer that patient to the Delta Dental customer service department for assistance at 800.422.4234. Identifying DeltaCare® USA members is crucial to following the proper claims-submission guidelines.
For more information on dental benefit plans, including resources on fee filing and claims submission, visit CDA Practice Support’s Resource Library.