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Frequently Asked Questions (FAQs)

For ease of searching the FAQs page, click on Edit in the menu bar of your web browser, click Find, then enter your search term in the box. If the below FAQs do not answer your question, please call Customer Service at 800-452-9310.


Benefits and Coverage


Open enrollment changes

Question
-What changes can I make at open enrollment?
Answer
Your company benefits administrator can give you more details and advise you when your company's open enrollment will occur.

Determining coverage in divorce

Question
-I am divorced. If my former spouse and I both have dental coverage, whose insurance covers our children first?
Answer
The parent named responsible for maintaining insurance would be primary and the other parent would be secondary. If the divorce decree or custodial agreement is silent regarding responsibility, the order of benefit determination is: (1) the plan of the custodial parent; (2) the plan of the spouse of the custodial parent; (3) the plan of the noncustodial parent; (4) the plan of the spouse of the noncustodial parent. If the parents have joint custody, then the parent with the birthday (month/day) earliest in the calendar year usually has primary coverage.

Define alternate benefit
Question
-What is an alternate benefit and how does it work? 
Answer
In cases where alternative methods of treatment exist, benefits are provided for the least costly professionally accepted treatment. This determination is not intended to reflect negatively on the dentist's treatment plan or to recommend which treatment should be provided. It is a determination of benefits under terms of the patient's coverage. The dentist and patient should decide the course of treatment. If the treatment rendered is other than the one benefitted, the difference between Delta Dental's allowance and the approved amount for the actual treatment rendered is collectable from the patient.

Assigning benefits

Question
-Can I assign benefits to my dentist?
Answer
Dentists who are participating with Delta Dental will automatically have payment assigned to them. If a dentist is not participating with Delta Dental, payment will be sent to the member. Delta Dental will assign benefits to non-participating dentists in Connecticut under the following circumstances: the group is an insured client, rather than a self-funded plan; proper authorization appears on the claim form; or the dentist submits a W-9 form (required for tax reporting purposes). More information can be obtained by contacting Customer Service or calling 800-452-9310.

Changing dentists in DeltaCare®
Question
-I participate in the DeltaCare managed care program. Once I have selected a dentist, may I change my primary care dentist? 
Answer
Yes. You may change your eligibility from one primary care dentist to another by phoning 800-722-3524 if you are located inside New Jersey, or 800-848-3524 if you are located outside New Jersey, or writing Flagship Dental Plans by the 15th of the month. The change will be effective on the first day of the following month. However, requests to change dentists should not be made if a patient is in the middle of treatment. If necessary, a Flagship Dental Plans representative can advise you on the definition of "middle of treatment."

Documentation for full time students
Question
-If my dependent child is eligible for benefits as a full time student, what documentation does Delta Dental require?
Answer
Please use this Student Documentation Verification form.

Coordination of Benefits (COB)
Question
-What happens when I'm covered by two dental plans (coordination of benefits)?
Answer
Having two dental programs (called "dual coverage") does not "double" your coverage. However, it may mean that you will have lower out-of-pocket costs. Usually, one program will be considered primary (usually the one through your job) and the other will be secondary (the one through your spouse's employer). The total payments of both the primary and secondary carrier cannot exceed the total approved amount or the total of what Delta Dental would have paid as primary. As an example, if your dental program covers 80% for fillings, and so does your spouse's, your program would cover the first 80% and your spouse's program would cover the remaining 20%. Some dental benefit plans have "non-duplication of benefits" provisions. This means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist. For example, if both the primary and secondary carrier pay for the service at 80 percent level, but the primary allows $100 and the secondary carrier normally allows $80 for the same treatment, the secondary carrier would not make any additional payment. However, if the primary carrier only pays 50 percent of the dentist’s allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. In this case, the secondary carrier would pay $14 ($80 x 80 percent - $50 = $14).

Referrals to specialists
Question
-Do I have to see a primary care dentist to get a referral to a specialist?
Answer
Referrals are not required if you have Delta Dental Premier®, Delta Dental PPOSM or Advantage Program. If you have chosen the DeltaCare plan, you will need to select a primary care dentist, who will coordinate a referral to the appropriate DeltaCare specialist.

Finding a participating dentist
Question
-How do I know which dentists participate in my plan in my particular area?
Answer
Click on the Find a Dentist link on our website to find a participating dentist near your home or office.

Checking deductible
Question
-How do I check if I have met my deductible and/or what is remaining on my maximum? 
Answer
You can verify your deductibles and maximums from our website via Benefits Connection. First-time users need to register by clicking on the “Register here” link under the Login To Your Account box on the right side of our website. You also can call our Customer Service department at 800-452-9310 and follow the voice prompts for the remaining maximum/deductible option.

I don't understand my Explanation of Benefits
Question
-I don't understand my Explanation of Benefits (EOB). Whom should I talk to? 
Answer
If you have a question about your Explanation of Benefits (EOB), (also known as a Notification of Benefits, NOB; and Notification of Payment, NOP), you can view an easy-to-read description of Delta Dental of New Jersey's Explanation of Benefits statement. You can also call Customer Service at 800-452-9310.

Individual Dental Plans
Question
-Does Delta Dental offer individual plans/policies? 
Answer
Delta Dental of New Jersey now offers affordable dental coverage for those without access to a group dental plan. Currently available to New Jersey residents only, our plans provide access to a broad array of dental services through our vast network of participating dentists. Our plans offer quality coverage options at competitive rates with automatic monthly payments. Learn more about our individual dental plans. Information for dentists about plan administration can be found here.

ID cards
Question
-Do I need an ID card? 
Answer
ID cards are not required and many employers do not issue them. Dental offices can verify your eligibility by logging into the secure area of our website. As a member, you can print an ID card by logging in to Benefits Connection and clicking the Print ID Card icon. First-time users register for Benefits Connection by clicking on the "Register here" link under the Login To Your Account box on the right side of our website pages. Dentists also can call Customer Service at 800-452-9310.

Treatment cost
Question
-Can I find out what my treatment will cost before I have it?
Answer
Yes, your dentist can submit a pre-treatment estimate, or pre-determination of benefits of your proposed treatment plan to Delta Dental. We will process it and send your dentist an Explanation of Benefits that shows what would be covered and how much you would have to pay. Please keep in mind that although a pre-treatment estimate may state Delta Dental will pay a certain amount for a procedure, it is not a guarantee of payment, as circumstances may change (e.g., your annual maximum could be met between the date the pre-treatment estimate was submitted and the actual date the service was performed; your coverage could be changed or terminated; you may obtain treatment from a different dental office).

Verify coverage
Question
-What does my plan cover? How can I verify dental coverage?
Answer
You can retrieve information about coverage for yourself and your covered dependents from Benefits Connection via the Login To Your Account box. First-time users need to register by clicking on the “Register here” link under the Login To Your Account box on the right side of our website. If you prefer, you can also call our Customer Service department at 800-452-9310.

Obtaining benefits booklet
Question
-How can I get a Delta Dental benefits booklet?
Answer
To obtain a benefits booklet, please contact your employer. You can retrieve information about your coverage from Benefits Connection via the Login To Your Account box. First-time users need to register by clicking on the “Register here” link under the Login To Your Account box on the right side of our website.

Cost for white fillings
Question
-Why did Delta Dental pay less for white fillings on my back teeth?
Answer
White fillings, or fillings made of composite resin, are considered to be optional. Dental amalgams, or what we normally think of as silver fillings, are less expensive and clinically equivalent to composite resins. Because of this, your plan pays for the least costly clinically equivalent fillings in back (posterior) molars.

Participating dentist charges up front
Question
-What if a participating dentist charges me up front?
Answer
We suggest our participating dentists not charge patients any more than their co-payment and deductible before Delta Dental has processed their claims. However, if a participating dentist does charge you up front, he or she is obligated by his or her agreement with Delta Dental to reimburse you anything over and above what Delta Dental determines the patient payment to be.

Frequency of cleanings and exams
Question
-How often can I have cleanings and exams, and are these services included in my plan maximum?
Answer
Each plan specifies how often cleanings and exams are eligible. You can check your benefits frequency limitations in Benefits Connection via the Login To Your Account box. First-time users need to register by clicking on the “Register here” link under the Login To Your Account box on the right side of our website. Once registered, you can click on Benefits Inquiry and then Frequency Schedule. You can also check with your benefits administrator or your plan booklet for the specific frequency limitation or call our Customer Service department at 800-452-9310. All procedures paid by Delta Dental are included in the plan maximum.

Switching plans
Question
-When can I switch plans?
Answer
Usually only during your company's open enrollment period. However, it is best to contact your employer's benefits department.


Benefits Connection and Customer Service


Username and password information
Usernames must be 8-20 characters long. Passwords must be between 8 and 20 characters, and must satisfy three out of these four requirements: 1. English uppercase characters (A through Z), 2. English lowercase characters (a through z), 3. Base 10 digits (0 through 9), 4. Non-alphabetic characters (for example: !, $, #, %). To protect and secure your protected health information online, we require Benefits Connection users to change their passwords every 90 days. You can change your username and password at any time. Just login to Benefits Connection, and then click “Profile” under “Other Tools.” If you forget your username or password, use the links under the Login to Your Account box on every page of this website.


ID numbers
Question
-What is the ID Number field referring to on the Benefits Connection registration page?
Answer
For members, the ID number is the number your employer uses to identify you (either your Social Security number or your unique ID). For dentists, the ID number is the employer identification number (EIN) of a business, fiduciary, or other organization.

Changing my address
Question
-How do I change my address?
Answer
There are three ways Delta Dental will accept a member change of address: (1) via notification by the U.S. Postal Service when you file a change of address form with them; (2) by submitting in writing a signed letter indicating your new address to our Correspondence Department; or (3) you may notify us of your address change via Benefits Connection. Please note: if you send employee address information to Delta Dental of New Jersey electronically, your employer will need to be notified of the address change.

I forgot my username and/or my password
Question
-What if I forgot my username or my password?
Answer
Click the "Forgot password" or the "Forgot username" links under the Login To Your Account box on the right side of our website. If you have forgotten both your username and password, please click the "Forgot username" link first, then go back and click the "Forgot password" link. If you are having difficulty logging in to Benefits Connection, please call Customer Service at 800-452-9310.

Contact Customer Service
Question
-How do I reach Customer Service and when are they available?
Answer
Customer Service Department hours are 8 a.m. to 6:30 p.m. Monday through Thursday, and 8 a.m. to 5 p.m. on Friday. The email address is service@deltadentalnj.com. The fax number is 973-285-4141. The phone number is 800-452-9310. Customer Service can help you with all issues related to Benefits Connection.

Claims


Mail claims
Question
-Where do I mail claims?
Answer
Mail all claims to: Delta Dental of New Jersey, P.O. Box 222, Parsippany, New Jersey 07054-0222. Fax claims to: 800-DAISYFX (800-324-7939). If you are a member of DeltaCare, address your correspondence to: Flagship Dental Plans, P.O. Box 369, Parsippany, New Jersey 07054. If you have DeltaUSA coverage through another Delta Dental Plan, please go to www.deltadental.com and click on the Plan Locator link for the correct mailing address.

Verifying claim status
Question
-How can I verify the status of a claim? Can I verify claim status on a patient?
Answer

You and your dentist can verify the status of your dental claims in Benefits Connection via the Login To Your Account box. All first-time users must register by clicking on the “Register here” link under the Login To Your Account box on the right side of our website and follow the prompts. You can also call Customer Service at 800-452-9310, and follow the prompts. Note: there is a 10-day waiting period for claims inquiries after your initial registration. If you are having difficulty viewing or verifying claims in Benefits Connection, please call Customer Service at 800-452-9310.

Time limit on claim submission
Question
-Is there a time limit for sending in claims?
Answer
Claims are payable up to one year from the date of service. Delta Dental must receive the claim one year from the date of service.

Obtaining claim forms
Question
-Where can I get claim forms?
Answer
You can download a copy from Benefits Connection. The dental office may also use standard ADA forms.

What is the NPI?
Question
-What is the NPI?
Answer
Part of HIPAA, the National Provider Identifier (NPI) regulation establishes one unique identifier for each health care provider. The NPI regulation seeks to eliminate multiple identifiers currently in use.

Can I submit electronic claims with COB to Delta Dental of New Jersey?
Question
-Can I submit electronic claims with COB to Delta Dental of New Jersey?
Answer
Yes. Dental offices can submit claims with COB to Delta Dental of New Jersey either electronically through clearinghouses or online through Benefits Connection. Primary carrier payment information should be provided in the appropriate field.

NPI and paper claims
Question
-Do I need an NPI if I only submit paper claims?
Answer
If you do not submit electronic transactions governed by HIPAA, which includes claims or benefits inquiries via the Internet, you are not required to obtain an NPI. However, we strongly encourage you to obtain and use an NPI to submit all of your claims once we are prepared to accept it. This will enable you to maintain only one unique identifier for use with all payers.

Should I submit claims electronically?
Question
-Should I submit claims electronically?
Answer
To determine if electronic claim submission is right for you, click on this interactive ROI calculator developed by the National Dental EDI Council.

Who is required to apply for an NPI?
Question
-Who must obtain an NPI?
Answer
All health care providers, defined under the regulation to include dentists, are eligible to receive an NPI. However, only "covered entities" are required to obtain an NPI. A dentist is a "covered entity" if he or she transmits electronic transactions governed by HIPAA, primarily electronic claim transactions. Dentists who access claims information or benefits via the Internet are also covered entities. Clearinghouses are also required to be able to accept and transmit the NPI by the federal compliance deadline.

How soon after I apply will I receive my NPI?
Question
-How soon after I apply will I receive my NPI?
Answer
It is estimated that an applicant will receive his or her NPI within 10 days after a properly completed application is received.

I am a dentist. How do I apply for an NPI?
Question
-How do I apply for an NPI?
Answer
According to the Centers for Medicare & Medicaid Services (CMS), you can apply for your NPI in one of the following ways:
1. You may apply through an easy web-based application process. The web address is http://nppes.cms.hhs.gov.
2. You may prepare a paper application and send it to the entity that will be assigning the NPI (the Enumerator) on behalf of the Secretary. A copy of the application, including the Enumerator's mailing address, is available on http://nppes.cms.hhs.gov. You may also call the Enumerator for a copy. The phone number is 800-465-3203 or TTY 800-692-2326.

 

COBRA

COBRA and Medicare
Question
-If a person is on Medicare or becomes eligible for Medicare, is he/she still entitled to COBRA coverage?
Answer
If the person qualifies for Medicare prior to becoming effective for COBRA, the person is entitled to COBRA coverage. If a person with existing COBRA coverage becomes eligible for Medicare during this time, the COBRA coverage ends.

COBRA and benefits
Question
-Do my benefits start over when I go on COBRA?
Answer
No. COBRA is a continuation of existing coverage. Maximums, deductibles, and tooth history carry over. Benefits remain the same.

COBRA rates
Question
-Where do the rates for COBRA come from?
Answer
If payment is to be made to Delta Dental of New Jersey, the rates may be obtained from the Delta Dental COBRA Department at 973-285-4145. If the payment is to be made to a different entity, rates may be obtained from the employer.

COBRA and covered dependents
Question
-When an employee's children reach the maximum age under the plan, how do the children switch to COBRA?
Answer
The employee must notify his/her benefits department, who will provide the necessary paperwork to enroll dependents.

COBRA and ID cards
Question
-After I enroll in COBRA, will I need to give the dentist an identification card?
Answer
No. When a member goes to the dentist, the member should provide his/her Member ID number and COBRA policy number.

COBRA payments
Question
-How do I make COBRA payments and where should I send the payments?
Answer

Payments are made on a monthly basis. Depending on who administers COBRA, payments will be sent to the administrator. The benefits administrator will be able to guide employees as to who collects the premiums.

COBRA coverage length
Question
-How long is a person covered under COBRA?
Answer
Depending on the circumstances of the qualifying event, coverage is 18, 29, or 36 months. Employees should ask their benefits manager.

COBRA and Coordination of Benefits
Question
-Can I be covered under COBRA and a second plan at the same time, and can benefits be coordinated?
Answer
Yes, you can be covered under COBRA and a second plan at the same time, but only if the second plan was in effect prior to the qualifying event for COBRA.

COBRA application
Question
-Where do I get an application for COBRA?
Answer
All paperwork pertaining to COBRA must come from your employer.

COBRA and disability
Question
-If I become disabled during the COBRA coverage period of 18 months, is the coverage period extended?
Answer
Yes. Disabled individuals are entitled to a total of 29 months of coverage. A member must provide the COBRA administrator with the proper documentation from a doctor.

COBRA and new employer
Question
-What happens if I return to work while on COBRA and receive benefits through the new employer?
Answer
Once someone becomes eligible for benefits through a new employer, the person is no longer eligible for COBRA coverage. If Delta Dental is administering COBRA, the notification must be sent in writing to: COBRA Department, Delta Dental of New Jersey, P.O. Box 219, Parsippany, NJ 07054.

 

 

 


 

 

 

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