Delta Dental offers dentists the flexibility of participating with one or more of our networks, which serve a variety of commercial, Medicaid, Medicare Advantage, and Medicare and Medicaid dual program members.
Below is a list of our networks and the programs which utilize them.
Delta Dental PPO™
Serves Delta Dental PPO (Standard), Delta Dental PPO (Point-of-Service) and Delta Dental Medicare Advantage™ members.
Delta Dental PPO (Standard)
Delta Dental PPO (Standard) is a preferred provider organization program. Participating dentists treat PPO members and are reimbursed based on their applicable Delta Dental fee schedule amount. Since the PPO program is a popular choice by employers, dentists who participate in this network may see an increase in patients seeking a participating dentist.
FAQs about participating with Delta Dental PPO
Delta Dental PPO (Point-of-Service)
Delta Dental PPO (Point-of-Service) combines the characteristics of Delta Dental Premier and Delta Dental PPO into one flexible program. Members who do not go to a participating Delta Dental PPO dentist can still receive treatment from a Delta Dental Premier dentist, but often at a higher out-of-pocket cost.
Medicare Advantage
Medicare Advantage plans are offered through health plan partners and the dental benefits are administered by Delta Dental. Participation in the Delta Dental PPO network includes participation with Medicare Advantage plans that use the Delta Dental PPO network and are administered by Delta Dental. Medicare Advantage members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits. A participating dentist cannot balance bill the member for any difference between their regular fees and the amount in the program fee schedule.
Healthy Kids Dental
Serves Delta Dental Healthy Kids Dental members.
Healthy Kids Dental
Healthy Kids Dental (HKD) is a program offered through the Michigan Department of Health and Human Services and is administered in part by Delta Dental. It provides dental benefits to children who have Medicaid and are under the age of 21. Reimbursement to Delta Dental HKD participating dentists for services rendered to Delta Dental HKD members is based on the Delta Dental PPO fee schedule. To receive benefits, members must go to a Delta Dental HKD participating dentist, and the dentist cannot balance bill the member for the difference between the submitted charges and the approved fee schedule amount. Participating providers are required by the State of Michigan to register their Type 1 NPI (individual) in the Community Health Automated Medicaid Processing System (CHAMPS). All incorporated businesses are also required to obtain a Type 2 NPI (business) and register it in CHAMPS. Find instructions on NPI and CHAMPS enrollment.
Delta Dental Premier®
Serves Delta Dental PPO (Point-of-Service) and Medicare Advantage members.
Delta Dental Premier
Delta Dental Premier is a standard fee-for-service program. Dentists submit their usual fees for each service rendered, and participating dentists are reimbursed based on the maximum approved fee. Members are responsible for their copayment and deductible (if any). Participating dentists always receive claim payments directly from Delta Dental and members prefer to seek treatment from a participating dentist because of the lower out-of-pocket costs.
Delta Dental PPO (Point-of-Service)
Delta Dental PPO (Point-of-Service) combines the characteristics of Delta Dental Premier and Delta Dental PPO into one flexible program. Members who do not go to a participating Delta Dental PPO dentist can still receive treatment from a Delta Dental Premier dentist, but often at a higher out-of-pocket cost.
Medicare Advantage
Medicare Advantage plans are offered through health plan partners and the dental benefits are administered by Delta Dental. Participation in the Delta Dental Premier network includes participation with Medicare Advantage plans that use the Delta Dental Premier network and are administered by Delta Dental. A participating dentist cannot balance bill the member for any difference between their regular fees and the amount in the program fee schedule.
FAQs about participation with Delta Dental Premier
Healthy Michigan Plan
Serves traditional adult Medicaid and Healthy Michigan Plan members
Healthy Michigan Plan
Healthy Michigan Plan (HMP) is a program offered through the Michigan Department of Health and Human Services and administered through health plans. HMP provides medical coverage, including dental benefits, to low-income Michigan residents over age 19 to 64 who are in the income segment just above traditional Medicaid. Delta Dental partners with health plans to provide the HMP dental benefit to their population.
Reimbursement to participating providers for services rendered to adult Medicaid and HMP members is based on the Delta Dental PPO fee schedule. All covered services will be reimbursed at 100 percent of the dentist’s submitted fee or the amount listed in the HMP fee schedule, whichever is less. The participating dentist cannot balance bill the member for the difference between their submitted charges and the approved fee schedule amount. Eligible adult Medicaid and HMP members can receive treatment from any Delta Dental HMP participating dentist. If a procedure is not listed in the fee schedule of covered procedure codes, it is not a covered service.
HMP participating providers are required by the Michigan Department of Health and Human Services to register their Type 1 NPI (individual) in the Community Health Automated Medicaid Processing System (CHAMPS). All incorporated businesses are also required to obtain a Type 2 NPI (business) and register it in CHAMPS. Find instructions on NPI and CHAMPS enrollment.
Delta Dental EPO
Serves Delta Dental EPO members
Delta Dental EPO
Delta Dental EPO (exclusive provider organization) is a fee-for-service program, and participating dentists are listed in our closed-panel directory. Members are required to receive services from Delta Dental EPO dentists. Treatment payment is based on the applicable fee schedule and member copayments. Participating dentists receive claim payments directly from Delta Dental and collect only copayments (if any) from Delta Dental EPO members. Delta Dental EPO serves commercial and government program members and is only available in Michigan, Ohio and Indiana. FAQ about participating with Delta Dental EPO.
Medicare Advantage plans are offered through health plan partners and the dental benefits are administered by Delta Dental. Participation in the Delta Dental EPO network includes participation with Medicare Advantage plans that use the Delta Dental EPO network and are administered by Delta Dental. Medicare Advantage members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits. A participating dentist cannot balance bill the member for any difference between their regular fees and the amount in the program fee schedule.
Medicare Advantage
Medicare Advantage plans are offered through health plan partners and the dental benefits are administered by Delta Dental. Participation in the Delta Dental EPO network includes participation with Medicare Advantage plans administered by Delta Dental. Medicare Advantage members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits. A participating dentist cannot balance bill the member for any difference between his or her regular fees and the amount in the program fee schedule.
FAQs about participation with Delta Dental EPO
Traditional adult Medicaid
Traditional adult Medicaid is a program offered through the Michigan Department of Health and Human Services and administered by health plans. Medicaid provides medical coverage, including dental benefits, to Michigan residents over age 21 who qualify for Medicaid. Delta Dental partners with health plans to provide the Medicaid dental benefits for their population.
Healthy Michigan Plan
Traditional adult Medicaid is a program offered through the Michigan Department of Health and Human Services and administered by health plans. Medicaid provides medical coverage, including dental benefits, to Michigan residents over age 21 who qualify for Medicaid. Delta Dental partners with health plans to provide the Medicaid dental benefits for their population.
Healthy Michigan Plan (HMP) is a program offered through the Michigan Department of Health and Human Services and administered through health plans. HMP provides medical coverage, including dental benefits, to low-income Michigan residents over age 19 to 64 who are in the income segment just above traditional Medicaid. Delta Dental partners with health plans to provide the HMP dental benefit to their population. Reimbursement to participating providers for services rendered to adult Medicaid and HMP members is based on the Delta Dental PPO fee schedule. All covered services will be reimbursed at 100 percent of the dentist’s submitted fee or the amount listed in the HMP fee schedule, whichever is less. The participating dentist cannot balance bill the member for the difference between their submitted charges and the approved fee schedule amount. Eligible adult Medicaid and HMP members can receive treatment from any Delta Dental HMP participating dentist. If a procedure is not listed in the fee schedule of covered procedure codes, it is not a covered service.
HMP participating providers are required by the Michigan Department of Health and Human Services to register their Type 1 NPI (individual) in the Community Health Automated Medicaid Processing System (CHAMPS). All incorporated businesses are also required to obtain a Type 2 NPI (business) and register it in CHAMPS. Find instruction on NPI and CHAMPS enrollment.
MI Health Link is a dual Medicare and Medicaid program offered through health plans through the Michigan Department of Health and Human Services and in partnership with the Centers for Medicare and Medicaid Services (CMS). Delta Dental partners with health plans to administer the dental benefit for their MI Health Link population. Reimbursement to all participating dentists for covered services rendered to members is based on the Delta Dental PPO fee schedule. A participating dentist cannot balance bill the member for any difference between his or her regular fees and the amount in the program fee schedule
TriState Advantage
Serves MI Health Link members.
TriState Advantage
MI Health Link is a dual Medicare and Medicaid program offered through health plans through the Michigan Department of Health and Human Services and in partnership with the Centers for Medicare and Medicaid Services (CMS). Delta Dental partners with health plans to administer the dental benefit for their MI Health Link population. Reimbursement to all participating dentists for covered services rendered to members is based on the Delta Dental PPO fee schedule. A participating dentist cannot balance bill the member for any difference between their regular fees and the amount in the program fee schedule.