Important Information for Providers:
Codes Requiring Attachments, Non-Covered Services, New Online Provider Credentialing Site, National EFT/ERA
Reminder on Required Attachments to Certain Codes
In an effort to reduce the number of information requests that are sent out, Delta Dental of Colorado recently worked with electronic submission clearinghouses, including Tesia, DentalXChange, and Change Healthcare (Emdeon), to require certain attachments for the CDT codes listed here. These requirements went into effect on July 1, 2017. We appreciate your time and attention to this matter as we work through some of the issues with these new edits, and we realize that this is a big change from the messages we have sent in the past to not submit any documentation but to wait until we ask for it through an information request. If you have any questions about this new policy, please contact your network management representative.
Non-Covered Services Legislation Takes Effect August 9
The Colorado state legislature recently passed legislation (SB-190) that prohibits dental plans from holding network dentists to their contracted fees for any dental procedures that are not "covered services," effective for dates of service starting August 9, 2017. Delta Dental of Colorado will comply with this new legislation in a manner that is consistent and easily understood.
Covered services are defined as "dental care services for which reimbursement is available under a covered person's plan, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other contractual limitations." In other words, if a clinical situation can be managed with a procedure (actual or alternative) that is ever a covered service under your patient's plan, the contracted fee for the procedure performed must be honored. We call this the "Never Ever Rule."
We have included some examples below:
And, as a reminder, if a service is disallowed, it is never chargeable to the patient because a disallowed service is considered part of another covered procedure code.
- If tooth whitening is not covered under a given group contract, submitted fees will be honored.
- If a plan covers two cleanings per calendar year, a third cleaning within a calendar year is denied due to a "frequency limitation." Because cleanings are covered by the plan, this third cleaning is still a "covered service" and will be held to the contracted fee for cleanings.
- A posterior composite is often subject to an "alternate benefit," so it will be considered a covered service because DDCO provides a benefit up to the cost of an amalgam. This legislation will not change the processing of such claims, and providers will continue to be held to the fee for the actual service rendered, even if it is an alternative to the allowed procedure.
This legislation will impact your patients to some degree in the form of higher out-of-pocket costs if they choose a procedure that is not covered by their plan. We have updated our claims system to reflect this change. If you have any questions about how this legislation will affect your patients' specific claims, please contact customer service at email@example.com or 1-800-610-0201.
New Online Credentialing Process Coming Soon
Delta Dental of Colorado is
changing how we credential providers. The basic process and timeline are the same, but you will be completing it online through a vendor partner.
We are collaborating with DDS Enroll by DentalXChange.com to allow you to submit all of your credentialing documentation online
This helps ensure that we are completing this process in a timely, effective manner, and that our network management team at Delta Dental of Colorado has more time to spend with providers on other strategic initiatives.
When you near your re-credentialing date, you will receive a letter from DDCO just as you have in the past. You will also receive a reminder email. All of the necessary documents and forms will be available at DDS Enroll, and their dedicated credentialing team will be available to answer all of your credentialing questions.
DentalXChange will integrate a series of digital features into the co-branded DDS Enroll platform, including:
Watch your mailbox and in-box for your credentialing information!
- Auto-Populating Fields
After forms are initially completed through DDS Enroll, the Question Wizard will save user information and autofill fields on any additional applications thereafter.
- Document Repository
DentalXChange supports the ability to upload required documentation or certifications needed to submit or renew credentials.
Users will have the option to electronically sign credentialing applications.
- Tracking Progress
Providers can view submitted credentialing applications and check the status of their credential renewals through DDS Enroll.
- Virtual Reminders
The program will send virtual reminders to users along with document expiration reminders to reduce the potential gap in renewal time or risk of termination from the network.
- Free Training and Troubleshooting
Users will have access to training, including live chat for quick questions as well as walk-throughs. Training will be provided directly from the credentialing team at DentalXChange, eliminating the need to contact insurance companies.
National EFT/ERA Rollout is Coming Soon
Delta Dental member companies have been working toward a National Electronic Funds Transfer/Electronic Remittance Advice (EFT/ERA) solution, which is nearing completion. This program allows a single enrollment through DDCO to receive direct deposit payments from every Delta Dental member company nationwide. Delta Dental of Colorado will implement the single repository for your ERAs by the end of the year. Once we are live with that piece, we will send you instructions for retrieving all your ERAs through DentalXChange (DXC) if you have opted in.
Currently enrolled with Delta Dental of (Your State)?
You will be pleased to know that nothing changes with your local enrollment. You can still retrieve your DDXX ERAs/EOPs/EOBs from our website just like you do today.
Currently enrolled in National EFT/ERA?
You can begin retrieving your ERAs from participating Delta Dental member companies now. The portal identifies which ones are live and which ones are not. You do not need to wait for DDCO to get ERAs from other member companies that are live.
Currently enrolled with any Out-of-State Delta Dental Member Companies?
If you are enrolled separately with any out-of-state Delta Dental member company's direct deposit programs, those separate enrollments will no longer be valid once the National EFT/ERA program is in place. You may or may not receive notices from each state with which you have separate contracts. If you are currently opted into national EFT/ERA, this will ensure that you continue to be paid by all other Delta Dental member companies electronically.
If you have already signed up for the national program, we will send you information once we have finalized the national ERA part of the program.