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Manage Your Delta Dental Benefits Plan

From plan setup to billing — and everything in between — find what you need to manage your dental plan here.

  • This guide can help you manage:

  • Delta Dental PPOSM plans

  • DeltaCare® USA plans

  • Standard dual choice options for your group

    If your group sponsors a flexible dual choice option, please see the Flexible Dual Choice page.

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Getting started

Know your dental plan

Understanding your coverage is essential to managing your dental plan, and can help you ensure enrollees get the most out of their dental benefits. Here are three ways to get to know your plan better:

  1. Group contract: Your group contract is the controlling document of your plan. Use it to find full information on administrative policies, limitations and exclusions, coverage details and payment agreements.

  2. Online Services: Once your plan is live, you can review benefits information by logging in to Online Services.

  3. Your account manager: If you can’t find the answer you’re looking for, contact your account manager.

Implementation

Once you’ve finalized your contract with your account manager, there’s an entire team of experts ready to help set up your dental plan. You’ll even get your own dedicated implementation manager, who’s ready to help with:

  • Initial eligibility and enrollment

  • Billing options

  • Dental benefits configuration

  • General plan setup support (wherever it’s needed!)

Open enrollment and new hires

Whether it’s open enrollment season or you’re simply onboarding a new hire, you can use these tools to help your enrollees understand their dental benefits from the start.

Customized dental benefits videos

For groups with 100 or more enrollees, Delta Dental offers customized videos to explain your dental benefits and how the plan works. Enrollees also learn about services that are available on our website and other useful information to make the most of their dental benefits.

The videos are available for Delta Dental PPOSM, DeltaCare® USA and dual choice dental plans. The videos can also be provided in Spanish upon request.

Shareable flyers

Use these flyers to help explain popular dental benefits topics to enrollees. If there’s another topic you’d like more information about, reach out to your account manager for additional materials to share.

Teleconference presentations

Give enrollees the opportunity to ask their questions directly through a hosted online benefit presentation via Microsoft LiveMeeting and/or conference call on our toll-free line. Ask your account manager to set one up!

Eligibility & enrollment

New group — loading enrollee eligibility

If you’re a new group, your account manager and implementation manager will work with you to find the best solution to handle initial enrollment. We accept initial eligibility transmission in the following formats:

  • Web enrollment (directly online, see OBR below)

  • Secure File Transfer Protocol (SFTP)

  • Secure email monitoring system

  • Secure website (Delta Dental pick up)

  • Enrollment forms

  • FTP with PGP encryption

  • Email with PGP encryption

Before starting the process, be sure you have the following information for each enrollee:

  • Full first and last name

  • Effective date of addition and/or change

  • Date of birth

  • Address

  • Complete Social Security number (SSN)

  • Group number

  • Division number

  • Relationship code (e.g., spouse or child)

Managing eligibility

Enrollees and dependents can be added at open enrollment or within 30 days of a qualifying event such as marriage, new hire, new child, etc. You can add, term or make updates to an effective enrollee’s eligibility information at any time (e.g., address change, name change). However, when you submit changes can impact billing; see Dates to remember below to learn more.

While there are a variety of ways to make eligibility updates and/or additions and terminations, the easiest and most efficient way to make changes is online.

Online updates

Manage your group’s eligibility securely online through our Eligibility Management Application (EMA). EMA allows you to make real-time updates to enrollee eligibility information so network dentists get the most up-to-date information about your enrollees — which can mean fewer mistakes and enrollee questions for you to handle.

In addition to updating enrollee information, you can also add and terminate enrollees within EMA. Contact your Delta Dental account manager to learn more and to sign up.

Manual updates

Delta Dental also accepts manual changes via our hard copy enrollment forms and secure electronic file transfer. Be sure to protect your employees' private health information (and follow HIPAA regulations) by sending files in an encrypted email.

Manual changes should be sent directly to our eligibility department as follows:

Manual eligibility by state of contract

CA, NV

Delta Dental PPO

atyourservice@delta.org

AL, FL, GA, LA, MS, MT, TX, UT, DC, MD, NY, PA, WV

Delta Dental PPO

eligibility@ddic.delta.org

To avoid delays, groups should not send enrollment information to the account manager.

For DeltaCare USA

Manual changes should be sent directly to our eligibility department at Enrollment-ER@delta.org.

Special provisions

Your group contract may also contain special provisions for eligibility additions and terminations, as well as provisions for retroactive changes. If so, your contract will serve as the governing document.

Checking eligibility status

You can check an enrollee’s eligibility status several ways. You’ll just need the enrollee’s full name, ID number or social security number and date of birth.

  1. Log in to Online Services. If you cannot view eligibility behind login, ask your account manager for help.

  2. Use our online Eligibility Management Application (EMA). Contact your account manager to sign up.

Still can’t find what you’re looking for? Reach out to your account manager for additional questions.

Billing & payment

Accepted forms of payment

Pay online

We offer plenty of payment options, but our Online Billing and Reconciliation Application (OBR) is the easiest way to make payments and keep track of past and present invoices all in the same place. OBR also allows you to:

  • View and download your current and past invoices in an Excel-based format

  • Reconcile your Delta Dental invoice with your electronic remittance file

  • Submit enrollee additions, changes and terminations for invoice reconciliation

Contact your Delta Dental account manager for more details and to sign up.

Alternate forms of payment

We realize no two groups are the same. You can also pay via:

  • Check

  • Wire transfer

  • PPO groups can also pay via Automatic Clearing House (ACH) credit or debit transactions

Delta Dental will help you initiate ACH debit transactions; you are responsible for initiating all other transaction types. You will work with your account manager during implementation to set up the method that works best for you.

Invoicing

Fully-insured clients

For fully-insured clients, Delta Dental generates invoices for both DeltaCare USA and Delta Dental PPO clients on a monthly basis using the current list of primary enrollees and the corresponding rate tier as a basis for calculating monthly premiums.

Self-insured clients

For self-insured (Administrative Services Only, or ASC/ASO) Delta Dental PPO clients, invoices have two major components: Administrative fee charges and claims reimbursement.

  1. Administrative fee charges are based on one of two methods as determined by your group contract:

    • Per enrollee per month (PEPM) administrative fees are based on the monthly eligibility list and the administrative fee rate to calculate the monthly administrative fee due for the period.

    • Percentage of claims administrative fees are calculated based on a percentage of claims dollars paid for the billing period (don’t worry, you’ll get a claims invoice for reference).

    • Example: If Delta Dental pays $100,000 in claims during a billing period, and your fee is 3%, your administrative fee would be $3,000.

  2. Claims reimbursement: Delta Dental will generate weekly or monthly invoices for claims paid during the period.

    • Weekly: You can pay by either Automatic Clearing House (ACH) or wire transfer within 72 hours of payment request.

    • Monthly: Your group will have to deposit and maintain a mutually agreed-upon pre-fund balance with Delta Dental. When the contract term ends, remaining amounts will usually be used to pay claims during the run-out period. After the run-out period, any remaining pre-fund balance will be returned. Administrative fee charges may also be included under the pre-fund arrangement allowing Delta Dental to draw down ASC fees monthly.

Invoice types

Pay as Billed — Delta Dental generates an eligibility roster each month based on the current eligibility database. Credits or debits for changes you report will be reflected in the next month’s invoice.

Example: Delta Dental bills your organization for 250 eligible enrollees; you pay for 250 eligible enrollees.

Pay Correctly or Pay as Adjusted — Similar to “Pay as Billed” except you can submit adjustments to Delta Dental’s invoice and pay the correct/adjusted amount (rather than wait for credits or debits to be reflected in the next month’s invoice).

Example: Delta Dental bills your organization for 250 eligible enrollees; you only have 240 eligible enrollees, so 240 is the adjusted amount of enrollees you pay for.

Self-Bill/Self-Pay — You may set up your account to submit your own prepared eligibility roster, and remit premium payment based on that roster. With this option, you forward premium payment accompanied by the eligibility roster premium detail at the enrollee level to Delta Dental. Enrollee additions, deletions, and changes in status must be clearly and separately identified. You can opt to stop or continue receiving an invoice from Delta Dental.

Dates to remember

We generate bills one month in advance (for premiums and applicable administrative fees).

Example: We bill on or around November 20 for the entire month of December.

When you’re adding or terminating an enrollee, the effective date determines how and when a new enrollee will show up in your invoice.

  • Changes received by the 15th of the month will be reflected in that month’s invoices.

  • If the changes are received after the 15th of the month, they will be reflected on the next month’s invoicing.

Retroactive changes

If you forget to add or term an enrollee, we will accept retroactive changes that occurred in the previous three months.

Example: It’s January, and you need to add or term an enrollee effective November 1. If you let us know by January 15, we can include either a retroactive premium or a credit for November, December and January on the February bill.

*Retroactive changes beyond three months will require additional approvals.

Track dental plan performance

Delta Dental makes tracking your plan performance easy. You get comprehensive data — from network and procedure utilization summaries to detailed financial analyses. Your account manager will provide you with periodic updates in an easy-to-read format, with a unique report in each section. You can use the reports to:

  • Track year-over year trends to develop or modify plan design

  • Analyze program performance compared to your benchmarks, and identify areas for improvement

  • Explore utilization trends

Talk to your Delta Dental account manager to make sure you’re getting the most out of your reporting package.

Dental claims

For Delta Dental Premier and PPO plans, Delta Dental dentists will submit claims for your enrollees. However, if an enrollee chooses to visit a non-Delta Dental dentist, he or she may need to file the claim themselves.

When a claim does need to be filed, share this helpful guide with enrollees.

For DeltaCare USA

With DeltaCare USA, there are no claims forms to complete when enrollees visit their selected DeltaCare USA dentist. For specialty care that is not performed by the enrollee’s primary care dentist, or if enrollees are traveling and need emergency care they may need to submit a claim.*

*Authorization for emergency treatment may be required. Refer to your contract for full details.

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