09/28/2016

Delta's Medicare requirement won't apply in California


Recent contractual amendments made by Delta Dental of Michigan, Ohio and Indiana effective Jan. 1, 2017, state that dentists who chose to opt out of Medicare Part D in these three states will no longer be eligible to remain Delta Dental network providers. This amendment is specific to Michigan, Ohio and Indiana and will only impact dentists in those three states, despite recent statements by a company advertising to help dentists with Medicare provider enrollment.

Delta Dental of California verified that it is not adopting the same policy and is in the midst of building separate Medicare networks for its PPO and DeltaCare HMO products to ensure its Medicare enrollees receive coverage on Part D prescriptions and to reduce patient complaints.

All dentists are encouraged to evaluate whether Medicare participation is right for them and their patients by taking appropriate action to enroll as a Medicare provider, enroll as an ordering/referring provider or opt out of Medicare participation by utilizing the resources provided by CDA and ADA. The Centers for Medicare & Medicaid Services, administrator of the Medicare program, has urged providers to submit one of the enrollment or the opt-out forms four or five months in advance of the Feb. 1, 2017, compliance deadline.

For more information, see "Medicare Provider Options," available at cda.org/resources.



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CDA Practice Support continues to receive many questions about the approaching deadline for  providers to opt in or out of the Medicare system. The Q-and-A below provides some basic facts about Medicare, dentistry and participating as a Medicare provider.

The Centers for Medicare and Medicaid Services has extended the deadline for dentists to either enroll as a Medicare Part D "ordering/referring provider" or opt out of the Medicare program entirely. The previous deadline was June 1, but it has now been extended to Feb. 1, 2017.

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