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Dentists

Frequently Asked Questions

 
Web Self Service Tool Pre-Estmate Submission
Claim Submission Coordination of Benefits (COB)
Claim Processing Overpayments
Claim Reprocessing Electronic Claims
Claim Review General Questions and Answers


Web Self Service Tool

How do I register to use the website?

Massachusetts providers can quickly self- register to use our website. In order to register you will need your 9 digit TIN (Tax ID Number). Do not enter an NPI. Click here to register. Out of state providers must first submit either a paper or electronic claim to Delta Dental of Massachusetts prior to being able to register for the website.


What is required to register for the website?

The Delta Dental Plan Association must have a record of your dental office in order for you to register to use the deltadentalma.com website. Out of state dental practices need both a Type-1 and Type-2 NPI on record. Massachusetts dental practices need a Type-1 NPI number on record. The exception for Massachusetts offices is for those who are LLC, PC or INC. These offices require a Type-2 NPI number.

 

Claim Submission

What is your claims mailing address?

Delta Dental of Massachusetts 
P.O. Box 2907
Milwaukee, WI 53201-2907

Can I fax a claim?

Yes, please fax claims to 617-886-1199
 

Can I submit a claim through your website?

Yes, as long as your dental office has registered to use our website. Click here to register.
 

How do I submit a new claim using your website?

Once you log into our website, click ‘Claims/Pre-estimates,’ and then click ‘Dental Claim Entry’ (or "Dental Pre-Estimate Entry").  
 
Fill out the following five sections of the Dental Claim Entry page:
1. Basic Information – Enter basic information for the claim.
2. Member Eligibility – Enter member information.
3. Service Lines – Enter services related to the claim.
4. File attachments – If necessary, attach any files needed for the claim.
5. Optional information – If necessary, in this section, you can:
*select the COB option (you must select this for it to appear on the page)
*select the Emergency option
*enter optional accident information
*enter your NEA attachment 
 
Once you’ve entered all your claim information, click the Submit button at the bottom of the page. You will receive a confirmation message, along with the assigned claim number.
 
To enter additional claims that have the same Date of Service, click ‘Enter a New Claim.’ To enter another claim with a different Date of Service click ‘Done’ and begin from step 1.
 
Please note: the system will time out if left idle for 30 minutes.
 

Does it cost anything to submit claims through the website?

No, online claim submission is free.
 

Why are paper claims mailed to Wisconsin?

We use a sophisticated scanning facility in Wisconsin.  Claims are then accessed electronically in Massachusetts where they are reviewed and processed.
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Claim Processing

How are claims payments issued to dentists?

Payments are issued directly to participating dentists and group dental practices weekly, along with Explanation of Benefits (EOB) forms. If a subscriber has a patient responsibility they will receive a copy of the EOB summarizing the services they received, the amount Delta Dental paid, and their co-payment and/or deductible.
 

Do you offer Direct Deposit of claims payments?

Yes, Direct Deposit is available to participating providers in Massachusetts who are registered to use the website (not yet available to out of state dentists).

The “Direct Deposit Registration Form” is found in the Related Documents section on the front page of our site, as well as “Direct Deposit Frequently Asked Questions” and tips for “Accessing EOBs on the Delta Dental MA Website”.

Practices receiving Direct Deposit will access their EOBs from our secure website to post their payments. Paper EOBs will not be mailed to offices registered with Direct Deposit.
 

How long does it take to process a claim?

Over 90% of routine claims are paid in less than 15 business days if they are complete and eligibility can be verified. 
 
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Claim Review

Will you return my x-rays?

No. X-rays are only retained for 3 business days, then recycled. They cannot be returned. Please never send original x-rays.
 

What procedures require reviewable documentation?

Please see the Delta Dental of Massachusetts List of Codes for In-House Review
 

Who makes decisions on claims?

Most claims are processed by our automated system. However, those treatments that require professional judgment to determine benefits are referred to our Utilization Management area, which consists of licensed dentists and dental professionals.
 
 

Claim Reprocessing

How can I request claim reprocessing?

Claim corrections can be submitted online or by mail.
 
Online
1. Login to our secure portal
2. Go to Online Claim Submission section to submit the claim 
3. use Notes box in the optional information section and type the appropriate Keyword such as “Correct” or “COB” with instructions for the adjuster
 
By mail
1. Mail requests on an ADA claim form, 2006 or newer.
2. Attach any important information.
3. Enter your request in the ‘Remarks’ section (Box 35). Use appropriate Keyword, such as “Correct” with instructions for the adjuster 
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Pre-Estimate Submission

What is a pre-treatment estimate?

A pre-treatment estimate, also called a predetermination, is a request provided by the dentist. It gives a non-binding cost estimate for a proposed treatment, including the amount that may be covered by the plan and the members out-of- pocket liability.
 

Can I send in a pre-approved Pre-Estimate with a handwritten date on it, and receive payment?

No, a new ADA Claim form must be submitted with the date of service. The approved pre-estimate can be attached to this. There is no need to resubmit reviewable documentation for the approved procedure. Clinical approval is valid for 12 months from the date of issue. PRE-ESTIMATES ARE NOT A GUARANTEE OF PAYMENT. BENEFITS ARE CALCULATED BASED ON CURRENT AVAILABLE BENEFITS AND PATIENT ELIGIBILITY. ESTIMATES ARE SUBJECT TO MODIFICATION BASED ON ELIBILITY, COORDINATION OF BENEFITS, THE CONTRACT ALLOWANCE, AND THE BENEFIT PLAN IN EFFECT AT THE TIME SERVICES ARE COMPLETED.
 
If you have questions regarding a pre-treatment estimate, please call Customer Service at 800-872-0500.
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Coordination of Benefits (COB)

Do you coordinate benefits up to the contracted allowance or the submitted charge?

COB is done up to the contracted allowance (not submitted charge). *The purpose of COB is to reduce the patient liability. Once the patient co-payment is completely paid, no additional benefits will be paid out. *An exception exits if the patient’s plan has a non-duplication clause. This information is available upon benefit breakdown.
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Overpayments

How do I fix a claim overpayment made to my office?

You can inform us of a claim overpayment online or by mail.
 
Online 
1. Login to our secure portal
2. Click ‘Contact Delta Dental of Massachusetts.’ 
3. In the message, click ‘Delta Dental of MA Claims,’ then enter a description and attach the claim number.
 
By Mail
1. Mail requests on an ADA claim form, 2006 or newer.
2. Attach any important information.
3. Indicate your request in the ‘Remarks’ section (Box 35).
    For example: “Reprocess- Correct patient name.”
 
When we identify an overpayment, a message will appear in the ‘Misc. Adjustment Detail’ section of your Consolidated Explanation of Benefits (CEOB) statement. That overpayment will then be automatically deducted from a future payment. This eliminates the need for you to mail refund checks to us. However, you will continue to have the option of manually mailing us a refund check. 
 

How do I send a refund check for a claim overpayment?

If you choose to send us a check, you will need to:
 
  • Promptly send the refund check to ensure it’s entered into our system prior to an automatic deduction occurring. This deduction typically takes place 30 days from the original notice. Please note: The notice on the CEOB is the only one you will receive regarding the overpayment – a separate letter will not be sent.
  • Include a copy of the Overpayment Adjustments page located at the end of the CEOB in the Misc Adjustment Detail section to ensure timely handling of your refund.
 
Please send refund checks with the required documentation to: 
 
Delta Dental of Massachusetts
Attention: Finance Department
465 Medford Street
Boston, MA  02129
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Electronic Claims

What is your Payor ID Number?

The Payor ID for Delta Dental of Massachusetts is 04614.
 

How do I get started with Electronic Claims Submission (ECS)?

Contact your practice management software system vendor.  They will help you become ECS ready and establish a link between your office and an electronic claims clearing house who will transmit your claims to all the insurance carriers you do business with.
 

I'm running practice management software. Is it easy to get electronic claims installed and working?

Yes, over 140 practice management systems have the ability to send claims electronically.
 

My practice doesn't have a computer. How can I take advantage of electronic claims?

Electronic claims do require a computer. Simple, stand-alone systems using only a standard, Windows®-based PC, printer, modem and telephone line access are often sufficient. 
 

Who actually does my electronic claims processing?

An electronic clearinghouse transmits claims to Delta Dental of Massachusetts and other insurance carriers who accept claims electronically. 
 

Is electronic claims processing accepted throughout the dental industry?

Yes, almost all major insurance carriers accept electronic claims submissions. 
 

Once I generate my claims electronically, how can I be sure I sent the right information and that the electronic clearinghouse has received my data?

A Submitter Report is generated before you send your claims.  It tells you if there are any problems with the claims (i.e. missing procedure codes, incomplete group numbers etc.). Once corrections are made, your data is sent to the electronic clearinghouse and a Transmission Summary is created to let you know the claims were received, completely and intact. 
 

Are there other costs are involved in processing electronic claims?

Yes, the electronic clearinghouse charges a small fee that varies depending on your practice management software vendor. There may also be an initial enrollment fee. 
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General Questions and Answers

How do I update my information (address, TIN changes, dentists in my practice, etc.)?

Out of state dentists must contact the local Delta Dental that services your state and give them the correct information. They will update your records with Delta Dental in other states.
 
Massachusetts dentists have a few options:
Mail: Provider Enrollment and Credentialing Department (PEC) at Delta Dental of Mass.
              465 Medford St.
              Boston, MA 02129
Email: DeltaDentalCredentialingUpdates@greatdentalplans.com
Fax: 617-886-1414
 

What is Credentialing?

Credentialing is a process that helps ensure quality. It requires screening for dentists applying for participation in our networks, and regular evaluations for those who are already part of our networks.

Delta Dental of Massachusetts has modeled its credentialing program on the National Committee for Quality Assurance (NCQA) criteria. Recognized as an authority by purchasers, this committee consists of representatives of employers, consumer and labor groups, health plans, quality experts, regulators and organized medicine. Most major managed care programs recognize and subscribe to the goals and criteria of the NCQA.
 
We conduct initial credentialing for all our Delta Dental providers and re-credential these dentists every three years.

If you have questions about credentialing, please call Professional Relations at 800-451-1249 x 61160. 
 

I have a group practice. Can each associate participate if we have different fees?

Yes, in this case checks will be issued to the group practice.  All group practices must submit claims with a common tax identification number (TIN), as well as the license number of the dentist who performed the service. Payment is based on the regional fee schedule that applies based on the practice zip code and the dentist’s specialty. 
 

How do I talk with a Professional Relations Representative?

Call 800-451-1249 x61160 with questions regarding network participation or dentist issues. 
 

Prior to joining a network, how will I know if your reimbursement fees are acceptable to me?

As part of the enrollment process, we will provide you with a regional fee schedule that is based on your practice zip code and your dental specialty.
 

Do you conduct office-billing audits?

Yes, we currently conduct office-billing audits on a random basis. An office may be selected if there is reason to believe a participating dentist is violating his or her agreement with Delta Dental of Massachusetts.