Alaska | Spring 2017
AlaskaCare clarification on implants and medical-in-nature procedures
The State of Alaska recently issued a benefit clarification for retiree members about implants. It states that the medical plan will cover the dental implant and anesthesia when the implant is necessary due to disease, including periodontal disease or accident. These services are subject to Aetna pre-certification requirements and plan provisions.
 
If a pre-certification request reflects the implant is necessary for a reason other than disease, periodontal disease, or accident, then Aetna will deny under medical and the request should be sent to Delta Dental of Alaska for further consideration.
 
All other implants will be covered under the dental plan in accordance with Delta Dental requirements and frequency limitations. The dental plan will consider the cost of the appliance (i.e. crown, bridge, denture, etc.).
 
Aetna will also cover services that are considered medical in nature for active and retiree members. For further clarification about these benefits, please visit Benefit Tracker or contact our Dental Customer Service team at 855-718-1768.

Delta Dental of Alaska adds 4,000 members with new employer group

Effective Jan. 1, 2017, Delta Dental of Alaska began administering the dental benefits for Chenega Corporation, an Alaska-based company with over 4,000 members nationwide. The group has selected the PPO plan option.
 
Delta Dental Preferred Provider Option (PPO) plans encourage members to utilize their in-network benefits by seeking treatment with a participating PPO dentist. 
 
Interested in becoming a preferred provider? 
Please contact our Dental Professional Relations team at 888-374-8905 or email dpr@modahealth.com to review our current fee schedule.

ADA adopts multi-tiered policy on opioids

Last October, the ADA House of Delegates passed Resolution 64H-2016, an ADA Statement on Use of Opioids in the Treatment of Dental Pain.

The American Dental Association (ADA) has published the following article on this policy, which includes recommendations for dentists: www.ada.org/en/publications/ada-news/2017-archive/january/ada-adopts-multitiered-policy-on-opioids.

To learn more on all of the ADA activities on opioids, please visit ADA.org/opioids .
Tips to expedite claims processing

When billing for procedures in multiple quantities, such as periapical x-rays or units of anesthesia, please create separate line items on the dental claim form. This will help ensure that all of the covered treatment is considered. Our system does not currently recognize the quantity, Box 29b of the 2012 ADA claim form, and will default to only allowing one unit if not listed individually. 

Introducing a new dental plan design

We are excited to share details about a new Delta Dental plan design called PPO MAC (Maximum Allowable Charge) plan. A MAC plan is a Delta Dental PPO (Preferred Provider Organization) plan that reimburses Preferred and Premier providers at the PPO fee schedule. A MAC plan differs from a traditional PPO plan because it allows Premier providers to balance bill the difference between their PPO fee and their filed fee. Adding this MAC plan to our dental products ensures a more competitive portfolio and offers another option for our employer groups. In addition, the premium for a MAC plan is less costly than Delta Dental of Alaska's traditional PPO plan and could offer cost savings to the member when dental services are performed by a PPO provider.
 
The grids below show the provider's network and fee administered for a MAC plan compared to a traditional PPO plan.

MAC plan:
Provider Network:
PPO Fee
Filed Fee
Non-Par Rate
Can Provider Balance Bill?
Preferred Provider (in-network)
X


No
Premier Provider (out-of-network)
X


Yes - The difference between PPO fee and filed fee
Non-Participating Provider (out-of-network)


X
Yes - The difference between non-par rate and billed charge

 

Traditional PPO plan:
Provider
Network:
PPO Fee
Filed Fee
Non-Par Rate
Can Provider Balance Bill?
Preferred Provider (in-network)
X


No
Premier Provider (out-of-network)

X

No
Non-Participating Provider (out-of-network)


X
Yes - The difference between non-par rate and billed charge

 
You will be able to identify a member with a PPO MAC plan by the Insurance Type displayed in Benefit Tracker. The Insurance Type will read - Delta Dental PPO - MAC plan (it's important to take note of the member's Insurance Type in Benefit Tracker since their member ID card will show the network as Delta Dental PPO without the MAC plan identifier).
 

 
Also, when you select Group Limitations, you will see a disclaimer under the Benefits section confirming that the member is on a MAC plan.

Provider Handbook
 

888-374-8905| dpr@modahealth.com | modahealth.com
601 S.W. Second Avenue
Portland, OR 97204