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Claims
Q. What is Delta Dental of South Dakota's claims mailing address?
A. Claims for all Delta Dental of South Dakota subscribers should be mailed to:
Delta Dental of South Dakota
PO Box 1157
Pierre, SD 57501
Q. What should be included on claim forms to Delta Dental of South Dakota?
A. Be sure to include the following on all claim forms: Subscriber's name and identification number
Patient's name and date of birth
Treating dentist's license number
The TIN or SSN that the dentist uses for IRS purposes
The dentist's National Provider Identifier (NPI)
Completion dates of services rendered
Tooth numbers or quadrants (indicate tooth surfaces where applicable)
Include complete dual coverage information including both the subscriber's
identification number and date of birth (attach the primary carrier's
statement if applicable).
Q. What date do I use on the claim form?
A. The date a procedure is completed. It is the insertion date for dentures and partial dentures. It is the cementation date (regardless of the type of cement used) for inlays, onlays, crowns, and fixed bridges.
Q. If my patient's spouse also has dental coverage, whose insurance pays first on the children?
A. Guidelines currently in effect in South Dakota state that the children will be considered primary by the plan of the parent whose birthday (month and day) occurs earlier in the calendar year. Subsequently, the plan covering the parent whose birthday falls later in the year pays second.
Q. How do we coordinate benefits for a patient that has dual coverage?
A. When coordinating benefits for a patient with dual coverage, please submit the claim to the primary insurance carrier first. Once your office has received payment from the primary carrier, please submit a copy of the explanation of benefits along with the claim to the secondary insurance carrier. If you are unsure which is the primary carrier, please contact Professional Services at 1-800-627-3961.
Q. Which procedures require x-rays to be submitted with the claim?
A. All crowns, veneers, onlays, build-ups, bridges, periodontal surgery, surgical extractions and implants. These x-rays should be included when filing the claim. X-rays should be mounted and include the patient's name as well as the dentist's name. If you are sending a panorex, please identify the right and left side.
Q. What procedures require narratives?
A. A narrative is required on all procedures that end in *999 or any procedure that doesn't fall within the guidelines of the ADA CDT codes.
Q. What procedures require periodontal charting?
A. Periodontal charts are required for many periodontal procedures. A current perio chart is needed for all surgical procedures and site-specific therapy.
Q. What is the correct date of service for multiple visit procedures (root canals, crowns, fixed and removable prosthetics)?
A. The correct date of service is the final fill date, the cementation date, and/or the delivery date. Delta Dental will only pay for completed dental services.
Q. If I have not received payment for a claim, should I send another copy to Delta Dental?
A. No, please do not send duplicate claims, as they slow down the processing of claims. Either check the status through our web site or contact our Professional Services Department at 1-800-627-3961.
Q. How do I check the status of a claim?
A. You may access claim status via our website, using the subscriber identification number. Once you are logged onto the Provider section of our website, select "Claims" from the menu on the left. For patients covered by other Delta Dental member companies, please contact the respective Delta Dental member company to verify claim status. Information on how to contact other Delta Dental member companies is available using the Delta Dental link from our website. Our Professional Services Representatives are available Monday through Friday from 8:00 a.m. to 5:00 p.m. (Central Time) at 1-800-627-3961 to assist you and your staff with claims status questions.
Q. How can I get a claim re-evaluated?
A. If you do not agree with Delta Dental's initial determination of benefits, and you have additional information to supply to support your request for reconsideration, please submit a copy of the Notice of Predetermination or a copy of the Explanation of Benefits form that shows the service in question along with a detailed reason for the re-evaluation. In addition to the request, please send all necessary x-rays, photos and clinical comments in support of your narrative to:
Delta Dental of South Dakota
Attn: Professional Services Department
PO Box 1157
Pierre, SD 57501
Q. As a participating dentist with Delta Dental, am I allowed to give small discounts?
A. The participating dentist agreement allows dentists to offer patient discounts only in occasional instances as a professional courtesy or because of financial hardship. If discounts are given routinely, you must also submit the discounted amount on the claim forms.
Q. How do I show fee discounts on claim forms?
A. Most dental offices will face a "fee discount" question from time to time. There are many reasons for giving discounts, including a patient's participation in a fee discount program. To report discounts on claims for patients who are Delta Dental enrollees, the lower, discounted fee (that is, the fee the dentist intends to collect as payment in full) must be entered as the fee for the procedure on the claim. This insures that the discount is applied to both Delta Dental's portion and the patient's portion. Entering the dentist's usual fee on the claim for any service that has been discounted would be considered a violation of the Participating Dentist Agreement, since it would be saying one fee is being charged when another actually is. When the fee charged to a patient is lower than the dentist's usual fee, and it is correctly entered on the claim as the actual fee charged, there is no effect on the dentist's participation with Delta Dental.
A. Claims for all Delta Dental of South Dakota subscribers should be mailed to:
Delta Dental of South Dakota
PO Box 1157
Pierre, SD 57501
Q. What should be included on claim forms to Delta Dental of South Dakota?
A. Be sure to include the following on all claim forms:
identification number and date of birth (attach the primary carrier's
statement if applicable).
Q. What date do I use on the claim form?
A. The date a procedure is completed. It is the insertion date for dentures and partial dentures. It is the cementation date (regardless of the type of cement used) for inlays, onlays, crowns, and fixed bridges.
Q. If my patient's spouse also has dental coverage, whose insurance pays first on the children?
A. Guidelines currently in effect in South Dakota state that the children will be considered primary by the plan of the parent whose birthday (month and day) occurs earlier in the calendar year. Subsequently, the plan covering the parent whose birthday falls later in the year pays second.
Q. How do we coordinate benefits for a patient that has dual coverage?
A. When coordinating benefits for a patient with dual coverage, please submit the claim to the primary insurance carrier first. Once your office has received payment from the primary carrier, please submit a copy of the explanation of benefits along with the claim to the secondary insurance carrier. If you are unsure which is the primary carrier, please contact Professional Services at 1-800-627-3961.
Q. Which procedures require x-rays to be submitted with the claim?
A. All crowns, veneers, onlays, build-ups, bridges, periodontal surgery, surgical extractions and implants. These x-rays should be included when filing the claim. X-rays should be mounted and include the patient's name as well as the dentist's name. If you are sending a panorex, please identify the right and left side.
Q. What procedures require narratives?
A. A narrative is required on all procedures that end in *999 or any procedure that doesn't fall within the guidelines of the ADA CDT codes.
Q. What procedures require periodontal charting?
A. Periodontal charts are required for many periodontal procedures. A current perio chart is needed for all surgical procedures and site-specific therapy.
Q. What is the correct date of service for multiple visit procedures (root canals, crowns, fixed and removable prosthetics)?
A. The correct date of service is the final fill date, the cementation date, and/or the delivery date. Delta Dental will only pay for completed dental services.
Q. If I have not received payment for a claim, should I send another copy to Delta Dental?
A. No, please do not send duplicate claims, as they slow down the processing of claims. Either check the status through our web site or contact our Professional Services Department at 1-800-627-3961.
Q. How do I check the status of a claim?
A. You may access claim status via our website, using the subscriber identification number. Once you are logged onto the Provider section of our website, select "Claims" from the menu on the left. For patients covered by other Delta Dental member companies, please contact the respective Delta Dental member company to verify claim status. Information on how to contact other Delta Dental member companies is available using the Delta Dental link from our website. Our Professional Services Representatives are available Monday through Friday from 8:00 a.m. to 5:00 p.m. (Central Time) at 1-800-627-3961 to assist you and your staff with claims status questions.
Q. How can I get a claim re-evaluated?
A. If you do not agree with Delta Dental's initial determination of benefits, and you have additional information to supply to support your request for reconsideration, please submit a copy of the Notice of Predetermination or a copy of the Explanation of Benefits form that shows the service in question along with a detailed reason for the re-evaluation. In addition to the request, please send all necessary x-rays, photos and clinical comments in support of your narrative to:
Delta Dental of South Dakota
Attn: Professional Services Department
PO Box 1157
Pierre, SD 57501
Q. As a participating dentist with Delta Dental, am I allowed to give small discounts?
A. The participating dentist agreement allows dentists to offer patient discounts only in occasional instances as a professional courtesy or because of financial hardship. If discounts are given routinely, you must also submit the discounted amount on the claim forms.
Q. How do I show fee discounts on claim forms?
A. Most dental offices will face a "fee discount" question from time to time. There are many reasons for giving discounts, including a patient's participation in a fee discount program. To report discounts on claims for patients who are Delta Dental enrollees, the lower, discounted fee (that is, the fee the dentist intends to collect as payment in full) must be entered as the fee for the procedure on the claim. This insures that the discount is applied to both Delta Dental's portion and the patient's portion. Entering the dentist's usual fee on the claim for any service that has been discounted would be considered a violation of the Participating Dentist Agreement, since it would be saying one fee is being charged when another actually is. When the fee charged to a patient is lower than the dentist's usual fee, and it is correctly entered on the claim as the actual fee charged, there is no effect on the dentist's participation with Delta Dental.
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