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 April 2018

 

Delta Dental


BrushUp Newsletter 
 

Delta Dental of Kansas' quarterly newsletter highlighting current topics for Participating Dentists and Staff
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PERIODONTAL MAINTENANCE CHANGES

Reduction in Documentation Requests

 

We have listened to your feedback, and have eased our policy on processing periodontal maintenance claims for patients who have had a lapse in treatment.

 

Delta Dental of Kansas (DDKS) Periodontal Maintenance Policy Changes as of 2/20/18:

  • DDKS will no longer request periodontal history within the last 24 months for 4910 periodontal maintenance.
  • The system is now looking for history of paid procedure codes 4240, 4241, 4260, 4261, 4341, 4342 &/or 4910 within the patient’s lifetime. 
  • If PAID history is found, the 4910 will automatically process as submitted.
  • If no history is found, such as in the case of a patient with a new DDKS policy, a letter requesting additional information will be sent to the provider asking for chart notes documenting previous periodontal history and maintenance. Please send the chart notes for the original periodontal surgery or SRP and the last few D4910 perio maintenance visits.

If you have questions, please contact your Professional Relations Representative.

PREDETERMINATIONS

 

Now Valid for 6 Months!

We have listened to your suggestions and have extended the period of time that predeterminations are valid. As always, if the predetermination on file is nearing its expiration date, contact customer service at 800.234.3375 or customerservice@deltadentalks.com and request an extension.

 

Why and When are Predeterminations Mandatory?

Are you aware that predeterminations with a current "valid to" date are mandatory for some procedures under some group dental plans? When mandatory, it is usually for treatment plans that involve implants, TMJ/TMD and bruxism. Predeterminations are required by some plans in an effort to reduce surprises for your patients when it comes to out-of-pocket costs. Please verify that a valid predetermination is in your possession before beginning treatment on your patient.

 

A few examples of some of the group plans that require a predetermination on implants:

  • Delta Dental Individual and FamilySM Platinum Plan
  • USD #259 - Wichita - Buy-Up
  • CURO Management LLC
  • WCNOC-Union-IBEW/ Non-Union/ Ret
  • Shawnee County
  • Kansas Building Trades
  • Security Benefit Corp
  • Newton Medical Center
  • Shamrock Trading Company
  • Berry's Arctic Ice LLC
  • Bartlett and West
  • Kansas Turnpike Authority
  • LRICO Services

While the patient bears responsibility for knowing his or her dental benefits and requirements for predeterminations, many patients rely on their dental office to assist them. If you are unsure whether or not a predetermination is mandatory, please review the patient's benefits by logging into the Dental Office Services portal or by calling Customer Service at 800.234.3375.

 

Submitting a Predetermination

Requests for predeterminations are made by submitting a proposed treatment in the same manner as a regular claim, omitting dates of service and the dentist's signature. We strongly encourage dentists to make predeterminations a habit for all treatments with costs in excess of $250 (whether mandatory or not), except in emergency and routine situations. For additional details, please review the "What you need to know" section of the Participating Dentist Handbook by logging into the Dental Office Service portal.

 

Register Now!

2018 Annual Seminar & Meeting 

 

When: Saturday, August 11, 2018   |   8:30 a.m. - 11:45 a.m.

Where: DoubleTree by Hilton   |   Overland Park, KS

3 CEUs

$20 per attendee

 

 

 

Punked by Plaque, by Dr. Brian Nový

The public seems obsessed with disinfecting everything from shopping cart handles to doorknobs. However, does it make sense to try and disinfect the mouth in an attempt to restore health? New revelations in cariology research indicate a better strategy may involve nurturing the growth of biofilm. But is such a dramatic paradigm shift consistent with oral health care? and could it go wrong?

 

Upon completion of this seminar, you'll be able to:

  • explain the mixed bacteria ecological plaque hypothesis
  • improve the prognosis of restorative treatment
  • simplify techniques to lower caries incidence
  • systematize risk assessment processes

 

Dr. Bryan Nový is the Director of Practice Improvement at the DentaQuest Institute, and an adjunct associate professor of restorative dentistry. He has served on the ADA Council on Scientific Affairs and as the Chairman of the CAMBRA coalition. The California Dental Association Foundation presented him with the Dugoni Award for "Outstanding Contributions to Dental Education", and in 2009, the American Dental Association awarded Dr. Nový and his office the title "Adult Preventive Care Practice of the Year".

NATIONAL EFT/ERA UPDATES & TIPS

 

Full implementation of the national EFT/ERA program is complete and all Delta Dental Member Companies currently making direct deposit payments are displaying your remittance advices on the DentalXChange (DxC) platform. You will no longer need to access separate websites to obtain ERAs!

 

Checking for New ERAs

Some, but not all, Delta Dental Member Companies are sending email notifications when new EFT payments are made. We recommend you log in to the Delta Dental of Kansas Dentist Portal each morning, check your local DDKS remittance and then check DxC for new ERAs for other Member Companies rather than rely on email notification.

 

Using the DxC Search Function

DentalXChange updated their advanced search function. Please note that currently, the process type is set to “Unprocessed”. If you are searching for a claim that has already paid, first change the processed type to “Previously Processed”, enter the identifying information in one or more of the payment or claim information boxes and then click “Search”.

 

 

REMINDER

Delta Dental of Massachusetts' Address

 

Delta Dental of Massachusetts changed their mailing address for claims and general correspondence almost two years ago, however some mail has continued to be sent to their old address. Up until this point the mail has been forwarded to the correct address, but mail will no longer be forwarded. Please compare the information you have on file for DDMA and make sure that you are using:

 

Delta Dental MA

P.O. Box 2907

Milwaukee, WI 53201-2907

Important Dates & Upcoming Events
 
Upcoming Office Closings:
  • May 28 - Memorial Day
  • July 4 - Independence Day
Upcoming Events:
 
Save the Date for DDKS' Seminars - Registration available at DeltaDentalKS.com/Register.
  • Annual Education Seminar - Presented by Dr. Brian Nový
    • August 11 - Overland Park, KS  |  $20 per attendee  |  Register Here
  • Dental Insurance 101 - Presented by DDKS Professional Relations Team

*Seminars are available for all Dentists and staff who participate with Delta Dental of Kansas. We reserve the right to cancel or reschedule any seminar that does not meet a minimum number of attendees.

Dental Office Changes or Updates: Please Notify Us

 

Please contact the Professional Relations department by phone at 800.733.5823, by fax at 316.462.3317 or by email at PR@deltadentalks.com for any dentist and/or office changes or updates.

 

When to notify us:

  • New and/or change of physical or payment address(es)
  • New and/or change of phone number(s)
  • A dentist joining or leaving an office
  • Closing of an office or practice
  • Tax information changes
  • New and/or changed NPI information
  • Retirement
  • Sale or purchase of practice
  • License status updates
  • Any information relating to action by a State Dental Board or any investigative, regulatory or law enforcement group
  • Any other notable updates or changes that effect your directory listing, claims payment, etc.

To ensure proper claims payment, please notify the Professional Relations department of all changes/updates in advance and note the future effective date. 

 

 

Meet Your PR Representative

 

Who is your Professional Relations Representative? Click here to meet your representative.
 

 

 

 

 

    

 

Delta Dental of Kansas  |  DeltaDentalKS.com

        Past Issues:

          January 2018

          December 2017

          July 2017

          April 2017

          March 2017 (special edition)

          January 2017

          October 2016

          July 2016

          April 2016