If the patient's benefits change before the treatment is completed (or starts), the estimate won't be accurate. Please keep in mind that the predetermination we provide is not a guarantee that benefits will still be available on the date treatment is provided. Predeterminations also reduce patients' confusion about coverage levels and enhance goodwill among the dentists, the patient and Delta Dental. Predeterminations allow your patient the opportunity to make proper financial arrangements for their portion of the treatment cost before actual work begins. In most cases, predeterminations are not required, but they are strongly encouraged. Am I required to submit a predetermination of benefits before beginning treatment on a patient? DDKS Automatically makes a payment each month until the treatment is completed, terminated, or the patient is no longer eligible. Generally, the claim is filed for the total amount for the entire treatment, starting with the banding date. Submitting a monthly claim for orthodontics is not necessary with Delta Dental of Kansas (DDKS). Do I have to submit a claim form every month for orthodontic work? sealing the pulp chamber and canal to the apex of the root), the date the final prosthesis is seated in the patient’s mouth, the date of insertion for removable prosthetic appliances, the date the remaining teeth are removed and the denture is inserted for immediate dentures and final cementation date for fixed partial dentures, crowns, onlays and inlays regardless of the type of cement. The definition of completion dates include: date root canal is completed (i.e.
The National Processing policy requires that multi-stage procedures are reported and benefited upon completion. We recommend that you apply your normal billing procedures to all patients. For a patient’s specific plan details, visit your online account or contact our Customer Service team.
Dental office toolkit dot customer sercice full#
If the group has selected an option that limits access based on the dentist’s participation level, indication is made on the top right hand corner of the dental insurance card - “Must see a PPO provider for benefits.” With these particular plans, if the patient chooses to see a provider outside his/her network, no benefits will be paid and full payment is the responsibility of the patient. How do I know if my patient is eligible for benefits? My patient has an exclusive Delta Dental PPO plan. Once you’re done inputting all of your patient’s identification numbers, a fax will be sent to you immediately. You will get an automated voice response that will lead you through simple instructions. You can also use Benefits Faxback to verify benefits and eligibility via fax by dialing 1-877-FAX-DDKS. Once logged in, select the Kansas Provider Toolkit, and then select Patient Benefits or Benefit Rundown. You can easily and quickly view your patient’s benefits/eligibility through your online account. How do I get a rundown of my patient’s dental coverage? If you have questions about Coordination of Benefits, please contact our Customer Service team. Some groups have specified a “carve-out” clause in their dental programs that might limit a secondary carrier’s payment. Total payments from both carriers cannot exceed 100% of the approved fee for the service. Children covered by parents who work for different employers are usually primary under the plan of the parent whose birthday occurs first in a calendar year (not necessarily the oldest parent). Generally, if the patient is covered as an employee and also as a dependent of an employee at another company, the coverage through the patient’s employer is primary.
If your patient is covered by both Delta Dental of Kansas and another dental carrier or a medical plan that offers dental coverage, Delta Dental coordinates benefits with the other carrier. My patient is covered under two dental plans.
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