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Specialty Referrals
- How to Refer Your Patients to a Specialist
DeltaCare has
recently modified the specialty referral process
in an effort to simplify the administration of
the DeltaCare program. For most endodontic and
oral surgery services, you may refer eligible DeltaCare
enrollees directly from your office to participating
DeltaCare specialists. Orthodontic referrals require
just a phone call to confirm orthodontic coverage
prior to referral.
Once you have
determined that the patient requires specialty
treatment:
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Confirm the
patient's eligibility from your current roster.
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Complete
the specialty referral form.
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Forward the
referral form along with the proper diagnostic
materials to the specialists or have the patient
take the form and radiographs with them to
the specialist.
When the general
dentist performs specialty services, please ensure
that the proper diagnostics are submitted when
requesting payment.
For treatments
such as primary care services that are complicated,
surgical or serial extractions and complicated
treatment plans, a specialty referral form must
be submitted with the appropriate diagnostic materials
for preauthorization prior to referral.
If there are
no network specialists within a 25-mile radius:
Please call the DeltaCare toll-free number and
a representative will assist in the referral to
a specialist in the area.
DeltaCare
is underwritten and administered by Flagship
Dental Plans, a wholly-owned subsidiary of Delta
Dental of New Jersey, Inc.
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