Delta Dental Update

• Delta Dental CDT Codes
• Delta Changes Its Methodology for Setting Fees
• Resources for Orthodontists on the Delta Dental Website

Update

By Thomas L. Thompson, D.D.S.
Delta Dental Committee Chair

Delta Dental CDT Codes for 2005

Contrary to notice in the June 2005 Newsletter, the ADA has instructed CAO to remove reference to specific CDT codes on the website or in any other media.  See information below to obtain the CDT codes.

Effective January 1, 2005, all practices billing for orthodontic services covered by Delta Dental Orthodontic benefits must use the 2005 CDT Codes. A code book can be purchased from ADA.

Practices must be particularly aware of the Oral Surgery section (D7000-D7999) of the 2005 Codes, which require the use of the Orthodontic Benefits for Oral Surgery procedures. Other procedures or codes require submittal to the medical carrier first, then enter the prime paid amount on the Delta claim.

More detailed information on these specific procedures/codes can be obtained by going to the Delta Dental Website at: www.deltadentalca.org/dentist/important_coding_info.html.

The ADA does not allow publication of specific codes without their purchase.  ADA has a variety of CDT products in print and CD-ROM formats available to dentists and their staff. ADA also offers licenses to commercial users. Products can be ordered via phone, fax or online through the ADA Catalog.

For further information and purchasing instructions, please visit the CDT Manual Home Page on the American Dental Association's website at www.ada.org/ada/prod/catalog/cdt/index.asp .

The ADA is the exclusive copyright owner of the Code on Dental Procedures and Nomenclature (Code), which is published in the ADA's dental reference manual titled Current Dental Terminology (CDT). CDT is revised and updated every two years.

June 2004: Delta Changes Its Methodology for Setting Fees

In March, Delta Dental of California (DDPC) notified all its member orthodontists that important changes were being made in Delta's fee filing methodology and in its participating dentists rules and agreements. These changes took effect on May 20.

Delta’s former "Composite Customary Fee” system was often frustrating and time-consuming. Delta used complex “weights” in its calculations that often took on the appearance of "lucky-guessing" on what would be accepted as fees.

Delta's goal in the new system is to make fees simpler and more logical, linking reimbursements to current fees charged.

With this new system, your current accepted fees and Delta's payments will not change. Delta will grandfather your current accepted fees into the new system.

However, when you file your next fee revision, Delta will evaluate your fees differently. With your next revision, Delta will calculate your "Maximum Plan Allowances" and send those rates to you.

Also, Delta has grandfathered your current accepted fees. If some of your accepted fees now are higher than the new maximum plan allows, you will still receive your higher, grandfathered fee.

Delta says that it will not lower grandfathered fees, even if you file new fees that are higher than the 80th percentile allowances.

Delta's new fees will still be based on the 27 "fee regions" which overlay markets with the 32 dental society boundaries.

The 80th percentile allowances for orthodontists will still be based only on the fees of California orthodontists. Delta will still update these allowances every six month. And member dentists can still submit their fee revisions every 12 months.

CAO recommends that you file your Usual Fee on all filing claims to Delta Dental and not your allowance (the 80th percentile recognized by Delta). Delta will only pay your accepted allowance for procedures or claims filed.

The advantage is that Delta will have statistics from your usual fees that will enable Delta to update their 80th percentile allowances levels every (6) months.

Delta Dental members can still re-file or update fees every (12) months. In the meantime Delta will reimburse your accepted allowance.

Participants will definitely have a learning curve with this new system and may expect to have a lot of questions.

Delta pledges to continuously update its website with new questions and answers. Visit the website at www.deltadentalca.org/dentist.

Resources for Orthodontists on the Delta Dental Website

Delta Dental of California (DDC) and its dental HMO affiliate, PMI Dental Health Plan, are the State of California's number one dental benefits carrier, delivering care to more than 17 million people statewide.

DDC's website home page provides additional information about Delta and PMI, Plans, and Information for both Enrollees and Dentists (Orthodontists).

In the Dentists section, there are tips for claims processing and a downloadable claims form.

Also available is "Section 2 of the Delta Dentist's Handbook," which has procedure codes and nomenclature from Current Dental Terminology, CDT-4, information on Delta’s program benefits and processing policies, and tips and guidelines for completing claims.

The website also describes half- and full-day seminars that DDC offers on claims processing and electronic claims.

Please visit Delta's website, www.deltadentalca.com for this and additional information.