Participation Information

Thinking of contracting with dental benefit carriers? First, think about the quality of the dental plan carrier and what to look for when reviewing the contract. Maybe you're considering contracting with Delta Dental? We know that you, as a dental care provider, share our passionate commitment - enabling good oral health.

Now more than ever, you must understand the extensive contracting arrangements and participation agreements that may be offered to you by dental benefit carriers. Knowing what to look for and what questions to ask before joining any network is key to a successful, long-term relationship that will benefit your practice.

Quality of the Dental Plan Carrier
Before reviewing the specifics of the agreement, you should look at the dental benefit carrier behind the contract. The success of any program will be determined by the quality, experience and track record of the carrier. A review of key areas will help you to avoid potential problems such as unexpected insolvency of the plan and gauge the probability of success. The following points should assist you in evaluating a dental network:

• Ownership of the carrier
• Number of years in the dental benefits business
• Number of dentists in the network
• The profile of dentists in the network
• Average dentist length of service in the network
• Financial stability of the carrier
• Number of employer groups covered
• Retention rate of employer groups
• Dentist representation in the company
• Availability of support staff and materials

Reviewing the Contract
Participation agreements are contracts which govern the relationship between you and the carrier. While some aspects of any agreement are determined by state and local regulation, contracts can vary greatly depending on the plan design used by the carrier. The following points are what you should look for when reviewing a contract:

• Basis for reimbursement
• Patient’s financial responsibility
• Scope of services covered
• Contract renewal and termination
• Claim verification process
• Patient referrals
• Referral for specialty services
• Credentialing requirements
• Malpractice requirements

Contracting with Delta Dental
Delta Dental’s Professional Relations staff can provide you with information about Delta Dental’s history and experience in dental benefits, detail provisions of the participation agreement, and review claim submission policy and procedures for you and your staff. If you have any questions about participation, please e-mail us at ddsrelations@deltadentalnj.com. Or contact our Professional Relations Department at 888-396-6641.

If you are interested in having a dental network coordinator visit your office to answer any questions you might have about participation and Delta Dental's programs, please call 888-396-6641.