Frequently Asked Questions
Patient Coverage and Benefits
Does Delta Dental offer individual insurance?
Yes. We understand that you may have patients who do not have access to group dental benefits. Research shows that people who have dental benefits are more likely to make appointments for regular exams. Now you can provide these patients with information about our affordable Delta Dental Individual and Family program for South Carolina residents and their families. Delta Dental Individual and Family plan members can select from several options for coverage that will meet their needs. Click here for more information or to enroll in these plans.
Are predeterminations required?
No, they are not required, but are suggested. A predetermination will let your patient know what out-of-pocket expenses to expect before your services are rendered.
When are checks mailed to the dental offices?
Checks are mailed from Delta Dental's office weekly on Thursday.
How can my office send dental claims and attachments eletronically?
Renaissance Electronic Services enables dental offices to transmit dental attachments (x-rays, perio charts, intra-oral pictures, narratives and EOBs), via the Internet. Delta Dental of South Carolina then views them as part of the electronic claim adjudication process. For dental offices, Renaissance Electronic Services accelerates claim processing and eliminates the need and cost to duplicate and mail x-rays and other necessary attachments.
Click here to receive information about electronic claims submission and attachments.
Does my office participate in the Delta Dental PPOSM network?
Please contact your professional relations representative to confirm your participation. This single piece of information determines how your patient’s benefits are paid. The benefits covered by your patient’s dental plan may vary depending on if the service is provided by an “in-network” or “out-of-network” dentist, and often by specific network participation—Delta Dental Premier® network or Delta Dental PPOSM network. . When your patient asks, “Do you accept Delta Dental?” Please respond with specific information about your network participation.
What is the correct mailing address for Delta Dental?
All paper claims should be mailed to P.O. Box 8690, St. Louis, MO 63126-0690.
Where can I get contact information for the other Delta Dental plans?
Delta Dental contact information may be useful to you when submitting DeltaUSA claims. To see a list of all of the Delta Dentals, click here.
How do I send claims electronically?
Your practice management vendor or representative will provide you with all the necessary instructions and paperwork for submitting claims electronically via your office computer.
If you do not have a practice management software system, but do have a computer, you can contact WebMDEnvoy at their toll-free number, 877-469-3263 (877-GO-WEBMD) to see if your computer is able to send electronic claims.
Delta Dental of South Carolina does not require any special enrollment for electronic submission. All services may be submitted electronically. Some services may require a narrative or x-rays.
Can you explain the electronic claims submission process?
The dentist submits claims electronically via the office computer to a clearinghouse. The practice management vendor is responsible for your computer software. This vendor also provides daily technical support and troubleshooting assistance.
The clearinghouse sends the claims to Delta Dental of South Carolina and other carriers that accept electronic claims. At the clearinghouse, all claims are reviewed for completion to ensure they are ready to send to each carrier. They also provide several reports that include important information for tracking claims and requests for additional information from the insurance carrier. The reports vary depending on your practice management system and your vendor will provide a copy of the standard clearinghouse reports.
Delta Dental can help. Contact us if you have questions about sending electronic claims via phone at 800-392-1167, or send us an email at Service@DeltaDentalMO.com.
Can you give me some tips for submitting electronic claims?
When selecting a clearinghouse vendor, make sure that the submitted dental practice name, address, TIN number and names of practicing dentists are the same as what you have on file with Delta Dental of South Carolina.
If you add or remove a dentist from your practice, you will need to notify both the clearinghouse and Delta Dental of South Carolina.
Verify that the Payor ID number is accurate. Delta Dental of Carolina's payor ID number is 43090.
Electronic attachments are accepted from National Electronic Attachments (NEA) FastAttach®, Renaissance Systems and Services (RSS) and Tesia-PCI. If films are being mailed in, please be sure to keep your originals and send in duplicate films or images.
When I send a claim to Delta Dental, should I also send an x-ray?
Not every procedure requires an x-ray for professional review. Procedures that routinely require diagnostic, oriented pre-operative radiographs of the treatment area are:
• Anterior single crowns (D2710 - D2794)
• Veneers (D2960 - D2962)
• Pulpal therapy (resorbable filling) (D3230 - D3240)
• Treatment of root canal obstruction (D3331)
• Incomplete endodontic therapy (D3332)
• Internal root repaid of perforation defects (D3333)
• Apexification (D3351)
• Crown lengthening (D4249)
• Full mouth radiographs for implants for groups that provide implant coverage (D6010 - D6077)
• Full arch radiographs for all initial bridges (D6205 - D6794)
• Electronic attachments are accepted from National Electronic Attachments (NEA) FastAttach®, Renaissance Systems and Services (RSS) and Tesia-PCI. If films are being mailed in, please be sure to keep your originals and send in duplicate films or images.