FYI

If you’re part of Delta Dental's Medicare Advantage (CMS) networks, your practice helps provide access to care for members enrolled through our health plan partners. With this growing population, providers and office teams play an increasingly important role in helping patients understand their benefits, access care with confidence and have a positive experience throughout their dental journey. Even small interactions, from confirming coverage to explaining benefits, can help reduce confusion, improve satisfaction and support continuity of care.

These are some ways you and your office team can empower positive experiences for your Medicare Advantage patients.
 

Be proactive in confirming coverage

Help prevent coverage challenges and hard conversations to create a smoother experience for both your practice and your patients. It’s important to note Medicare Advantage patients may identify themselves by their medical plan rather than Delta Dental and may present a health plan ID card instead of dental coverage information. Verifying eligibility and benefits through Provider Tools helps avoid confusion, reduces delays and ensures patients receive accurate information about their coverage before treatment begins.

Tips:

• Verify eligibility and benefits prior to appointments (when appropriate).
• Ensure office staff understand Medicare Advantage network participation and benefit considerations.
   

Be mindful of wait times and communication

Longer wait times can be particularly challenging for older adults, especially those with mobility, health or transportation considerations. Clear communication and thoughtful scheduling make patients feel respected and supported.

Tips:

• Inform patients promptly of any delays.
• Provide realistic expectations for when patients will be seen.
• Consider scheduling accommodations for seniors who may benefit from quieter times of day.

Be clear about benefits, costs and treatment options

Many Medicare Advantage patients carefully manage their health care expenses and appreciate knowing their costs and coverage upfront. Unexpected costs are one of the most common drivers of patient dissatisfaction. Discussing coverage limitations, optional upgrades, non-covered services and estimated out-of-pocket costs before treatment can help patients make informed decisions and avoid surprises.

Tips:

• Discuss benefits coverage, treatment options and plan considerations before treatment begins.
• Provide written treatment plans that clearly outline recommended care, optional upgrades and non-covered services.
• Submit pre-treatment estimates when appropriate for more complex or costly services.
• Explain any costs associated with non-covered services or material upgrades.
• Encourage patients to ask questions and understand their options before proceeding.

Be attentive and reassuring

A personalized, patient-centered approach helps Medicare Advantage patients feel heard, respected and confident in their care. Some patients may also feel anxious about dental treatment, costs or changes in their oral health; reassurance can help ease those concerns.

Tips:

• Take time to understand each patient's individual needs, health concerns and treatment goals; allow time for questions and be open to transparent conversations.
• Explain procedures in a clear, supportive manner; help patients understand what to expect during and after care.
• Confirm patient understanding before moving forward with treatment.

Be straightforward and use plain language

Use everyday language instead of technical terms to reduce confusion. Dental procedures and terminology can be difficult for patients to understand; create clarity instead.

Tips:

• Replace technical terms with easy-to-understand explanations.
• Clearly explain why treatment is recommended and what options are available.
• Provide written materials that reinforce key information discussed in the visit.
• Consider that some patients may need additional support understanding dental terms, treatment recommendations or benefit information.

Be prepared with the right tools and resources

Accurate provider information and timely responses support a smoother experience for Medicare Advantage patients and simplifies interactions with Delta Dental. Use available resources to help patients access the information and care they need.

Tips:

• Use Provider Tools to upkeep current practice, demographic and directory information.
• Report practice and office changes as soon as possible.
• Utilize self-service resources for eligibility checks, benefits information and pre-treatment estimates.

Be sure to submit complete claims and encounters

Timely and complete claims and encounter submissions help support accurate benefit administration, patient communications, care coordination and regulatory requirements. Make sure your office submits all services provided, including non-covered services when applicable, to help ensure patients receive appropriate denial notices and appeal rights.

Tips:

• Submit timely encounter and claims submissions, including supporting documentation when requested.
• Provide complete claims documentation to streamline reviews and improve turnaround times.
• Respond to records requests within seven calendar days.
• Understand the grievances and appeals process to help reduce delays and support timely case resolution.
• Refer to the Provider Handbook and available resources in Provider Tools for additional information and requirements.

Every interaction helps influence the overall patient experience with their provider, Delta Dental and their medical plan. By helping patients understand their benefits, setting clear expectations and supporting a seamless experience, your office plays an important role in improving satisfaction and access to care for this growing population.