Medicaid, Medicare and government program updates
Thank you for providing quality care to our members!
Private pay form reminder
Prior to rendering any non-covered services for members in the Healthy
Michigan Plan, Healthy Kids Dental, adult Medicaid or MI Health Link programs, these programs, a participating provider must verify a member’s eligibility for the service.
If a service is non-covered, the provider must inform the member of available alternative covered services prior to recommending or rendering the non-covered service.
If a member wishes to proceed with the non-covered service, a private pay form must be completed by the member on the date treatment is performed. Please note that if a private pay form is not obtained, the treatment is not billable to the member.
Tips for using a private pay form:
- A private pay form for non-covered services should only be considered if there are no alternative covered services available or the member refuses alternative covered services.
- Reasonable efforts should be made to obtain previous radiographs prior to charging the member for new radiographs using a private pay form.
- If a service is a covered service but is determined to not be medically necessary, it is not billable to the patient, regardless of what is indicated on a private pay form.
- If prior authorization is required for a service, it must be submitted and processed through Delta Dental. A private pay form cannot be used to charge a member for a service that was denied because prior authorization was required but was not submitted.
- Providers should not use non-covered services as a barrier to members obtaining covered services under the dental plan.
- Private pay forms should only be used after benefits and eligibility have been verified, you have confirmed a service will not be covered and you have confirmed the member wants to move forward with the non-covered service instead of any available alternative. Generic financial consent forms, non- specific forms, or forms that say treatment may or may not be covered are not acceptable as private pay forms for Healthy Michigan Plan, Healthy Kids Dental, Medicaid or MI Health Link members.
Delta Dental recommends using the updated sample private pay form available here.
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Secure messaging now available on DOT
The Dental Office Toolkit is one of the most useful tools in your office. It's now even better thanks to the recent release of secure messaging. With this enhancement, you can respond to an Information Request (IR) electronically. This will improve the provider experience and allow for:
- Centralization of all provider communications
- Ability for reconsideration requests and documentation capture
- Improved processing time of claims
You can learn more about DOT here.
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Register for Delta Dental's free CE courses
Have you checked out the new free Continuing Education courses? These courses are now available:
- Implicit Bias—Inclusive Engagement
- Risk Management & Record Keeping
- Women's Oral Health Issues
- Premedication for Invasive Dental Procedures
These courses are available online at no cost to our participating providers and their hygienists, assistants and office staff.
Visit www.deltadentalmi.com/onlineeducation to learn more.
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Why choose EFT?
Electronic Funds Transfer (EFT), or direct deposit, has become a standard payment method across industries, including health care. As a dentist, you want fast, secure payments. EFT delivers funds directly to your account with speed and less hassle.
Delta Dental of Michigan, Ohio, and Indiana recently introduced security upgrades to make EFT even safer:
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New EFT accounts require a one-time passcode (OTP) verification
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Electronic OTPs are emailed to the address used during credentialing
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Paper OTP notices will continue to be mailed to the U.S. credentialing address
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Multifactor authentication (MFA) will launch in Q2, with additional password-related safeguards coming soon
These updates enhance existing protections like Transport Layer Security (TLS) and AES 256-bit encryption.
EFT Benefits
EFT is quicker and more efficient than paper checks. Payments are sent directly to your bank account, typically within hours. Depending on your bank, funds may be available 3–5 business days after claim submission. EFT also removes the risk of lost or stolen checks.
Electronic Remittance Advices (ERAs) are issued with each EFT payment, offering detailed information online—cutting out manual check handling and deposit tasks.
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Appointment scheduling
When you provide care to patients with Medicaid or Medicare benefits, you have the opportunity to address critical gaps in their oral health and make a positive impact on their overall health.
If you are scheduling patients who have Healthy Kids Dental, Healthy Michigan Plan or MI Health Link benefits, remember that they must be seen or scheduled within a set time frame. These benchmarks are based on treatment urgency and are required by the Michigan Department of Health and Human Services. Find these benchmarks in your participation contract or below for general practitioners or pediatric dentists:
- Urgent care—see within 48 hours
- Routine services—schedule within 21 business days
- Preventive services—schedule within six weeks
- Initial appointment—schedule within eight weeks
- Emergency services—provider must be available immediately, 24/7
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Recredentialing process
Delta Dental recredentials network dentists every 36 months as part of your Delta Dental participation agreement. This process is done through PACT, an electronic enrollment and credentialing tool that allows you to complete required documentation, receive real-time application status updates and view archived submissions.
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Applying for an NPI
Do you know which NPI you need?
All covered health care providers, health plans and health care clearinghouses must use a 10-digit National Provider Identifier (NPI) in their administrative and financial transactions. This is required by HIPAA Administrative Simplification regulations.
There are two types of NPIs.
- Type 1—Individual health care providers who are sole proprietors (not incorporated)
- Type 2—Organization health care providers who are incorporated (incorporated individuals), group practices, clinics, county health departments and partnerships
Learn more about which NPI you may need and the steps to take.
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