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Articles
Code Changes, Policy Revisions Announced
Time to File Fees for CDT-2007
Implants Processing Policy Reminder
Patients Can Download, Print ID Cards
What to Do When Treatment Results from Accident or Occupational
Injury
Code Changes, Policy Revisions
Announced
The Delta Dental of New Jersey and Delta Dental
National Processing Policies have been revised to
incorporate CDT-2007 as well as other policy changes,
effective January 1, 2007.
An abbreviated list of the policy changes is available
on our Web site at www.deltadentalnj.com. Click “Dentists” and “CDT-2007
Code Changes and Delta Dental National Policy Revisions.”
To obtain a CDT-2007 manual, please contact the American
Dental Association catalog sales at (800) 947-4746
or www.adacatalog.org.
Time to File Fees for CDT-2007
Delta Dental suggests participating dentists update
their “usual” fees for the new CDT-2007
procedure codes, which we will begin accepting January
1, 2007.
An Abbreviated Confidential Survey of Fees form is
available in the secure area of our Web site at www.deltadentalnj.com.
Click “Dentists” and log on to Benefits
Connection.
Implants Processing Policy Reminder
Delta Dental processes payment for implants and
procedures related to implants according to the terms
of the client's contract. Depending on the contract,
the implants may be payable, not covered, or have
an alternate benefit applied to them. A pre-treatment
estimate is always recommended before performing
these services.
Patients Can Download, Print
ID Cards
Delta Dental doesn’t require ID cards, and
many employers do not issue them. However, many dental
offices ask for ID cards anyway. Many members told
us they wanted the option of getting ID cards if
they needed them.
We listened to our members. Delta Dental recently
launched online ID cards for members. This enables
them to print ID cards as often as they need.
Members will access their online ID card through
Benefits Connection, the secure area of our Web site
where they can also obtain detailed information about
their dental benefits. They just need to click the
icon on the top left of the screen after registering
for Benefits Connection. The card will be presented
to them for printing. The ID card will include their
name, group number and the Delta Dental program in
which they are enrolled.
This service will be available to all members except
those enrolled in Delta Dental Patient Direct and
DeltaCare. DeltaCare members needing replacement
cards should call DeltaCare Customer Service at (800)
722-3524.
What to Do When Treatment Results
from Accident or Occupational Injury
Dentists must include the following information
on claims where treatment is the result of an accident
or occupational illness or injury:
- Date of injury or illness.
- If the injury is the result of an auto accident,
the state in which the accident occurred.
All information regarding the accident, injury or
illness must be correctly and completely disclosed
at the time of the claim submission.
If this information is not correctly disclosed,
in some cases Delta Dental of New Jersey may make
a payment that is not due, or the total payments
of all carriers involved may exceed approved amounts.
Treatment that results from accidents or occupational
illness or injury often must be processed by other
carriers first.
- Claims for treatment due to an auto accident—First
submit to the personal injury protection (PIP)
carrier.
- Claims for treatment due to accidental injury—First
submit to patient’s medical carrier.
- Claims for treatment due to occupational injury—First
submit to patient’s employer’s worker’s
compensation carrier and/or medical carrier.
Failing to correctly disclose other carrier coverage
for dental services is one of the unacceptable billing
practices reviewed during the claim verification
process. It can result in overpayments that are recoverable.
If claim forms are intentionally submitted incorrectly,
it can be considered a fraudulent attempt to gain
benefits.
For more information, please refer to:
- New Jersey State Board of Dentistry, Administrative
Code [NJAC 13:30-8.10]
- The General Statutes of Connecticut [Volume 7,
Title 20, Chapter 379 Sec. 20-114]
- The Delta Dental of New Jersey Participation
Agreement
- The Delta Dental of New Jersey Dentist Handbook
for Participating Dentists, Chapter 4, Form
Completion, Chapter 7, Coordination of Benefits,
and Chapter 11, Claim Verifications
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