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CDA Member FAQ re: Delta Dental 2023 Contractual Changes

September 05, 2022 1036

What are the changes Delta is making and why?

The Delta Dental announcement addresses a shift to regional standard Premier fee schedules (thereby eliminating Premier fee fillings), creating an aggregate increase for PPO general dentist fees, and reducing Premier reimbursement for most oral surgeons, endodontists and periodontists.

Why is Delta eliminating the fee filing process for Premier providers?

As stated in the announcement, elimination of the fee filing process is meant to reduce the administrative burden to Delta Dental, participating dentists and their practices.

What can CDA do to help me with the changes to the Delta Dental plans?

  • CDA understands changes to the Delta Dental participating dentist agreements affect many dental practices, which is why CDA offers expertise through Practice Support and a variety of resources to assist members with navigating contractual changes with dental plans. As a member benefit, the Evaluating Dental Benefits Plans Checklist helps dentists analyze how Delta Dental contractual amendments and fee shifts may impact their practices.
  • For dentists who seek an additional level of expertise and assistance evaluating how a specific dental plan contract impacts to their practice, CDA offers an affordable consulting service. This service helps dentists better understand benefit plan provider contracts in relation to their unique patient base, procedure mix and fees.

Where can I find more information from Delta Dental to assess the contractual changes to my practice?

In addition to the information provided in the letter you received, CDA’s litigation settlement with Delta Dental requires Delta Dental to provide each Premier contracted dentist with an individualized potential financial impact statement of any reductions based on 12 months of claims submissions to Delta Dental (from the most recent complete quarter). CDA recommends reviewing the impact statement provided as well as the new proposed fee schedules available on the Delta Dental Provider Portal as of Sept. 1. For questions about the announced changes, you are urged to contact Delta Dental directly at 888.742.4099 or [email protected].

Does CDA know the range of fee increases or reductions for impacted dentists?

No, the changes to fees will vary by dentist, specialty, region and procedure code.

As a newly contracting provider with Delta Dental of California, am I still able to submit my Premier fees now?

Yes, the shift away from filed Premier fees to a standard Premier fee schedule will not occur until Jan. 1, 2023. For more timely fee approval, we strongly encourage you to submit your proposed Premier fee schedule utilizing the online submission tool found on the Delta Dental provider portal.

Can CDA do anything on behalf of members who will see a fee decrease? How is this different than in 2013 when CDA sued Delta over contractual changes?

CDA will evaluate the announced changes and determine whether any legal or legislative action would be appropriate. As a reminder, the 2013 litigation between CDA and Delta Dental was successful in blocking potential fee reductions for the past 9 years, while also providing additional disclosures to dentists in the event of a reduction or significant contractual amendments. During five years of hard-fought litigation, CDA successfully blocked Delta Dental’s attempt to change the PDA to allow reductions to Premier fees, saving dentists more than $600 million from potential fee reductions. Additionally, Delta Dental was ordered to pay $65 million to Premier dentists whose requests for fee increases were limited by Delta Dental’s inflationary adjustment percentage methodology. The settlement also requires Delta Dental to provide 120 days’ notice to dentists prior to fee adjustments.

Are other dental plans going to make significant contractual changes or adjust reimbursement rates?

CDA is not aware of any other plans announcing fee changes or making significant contractual changes at this time. The association strives to stay in front of the changes in the dental marketplace with regular communication with many dental benefit plans, but we cannot predict what future reimbursement changes may be forthcoming. Moreover, CDA cannot negotiate reimbursement rates on behalf of its members due to antitrust concerns.

If you could recommend one action for dentists to implement that would make a difference with dental plans, what would it be?

In addition to carefully evaluating the impact of any plan contract to your patients and your practice, submitting your usual, customary and reasonable fees on dental claims is crucial to accurately reporting the cost of care to dental plans. Do not submit your contracted fee as the claim amount. Dental plans utilize the submitted fees on claim forms as part of the analysis of fee schedules and the need for any changes to provider reimbursement.

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