FYI

As we begin the new year, we want to empower you to set your practice up for success. Below is a quick summary of a few important topics that’ll help you enhance patient experiences, achieve clearer communication and run smoother operations.
 

Deliver high-quality, patient-first care

Expand quality care beyond clinical treatment

Every interaction your patients have with your practice is critical to their experience. We encourage you to:

• Maintain a warm, professional and respectful environment throughout the visit.
• Support equitable, inclusive care by training your staff in cultural competence.

Communicate benefits clearly and confidently

To help your patients make informed decisions and avoid unexpected costs, we encourage you to:

• Verify eligibility, coverage levels, frequency limits and annual maximums before treatment begins.
• Submit pre-treatment estimates to Delta Dental to support transparent conversations.
• Explain coverage in simple, patient-friendly language.
• Keep documentation clear and complete — including treatment plans, financial consent forms and clinical notes.

Ensure appropriate access to care through scheduling standards

Meeting access-to-care expectations supports your patients and strengthens the overall patient experience. Please ensure that:

• PPO patients can access:
  • Non-urgent initial appointments within 36 business days.
  • Preventive/hygiene visits within 40 business days.
• DeltaCare® USA (DHMO) patients receive:
  • Non-urgent initial appointments within 36 business days.
  • Preventive dental care appointments, such as hygiene appointments, should be available within 40 business days of the patient's request.
  • 24/7 triage or after-hours support for severe pain and emergencies.
  • Wait times of no more than 30 minutes when patients arrive on time.
• Missed or cancelled appointments are followed up promptly to reschedule. 

Strengthen billing accuracy for faster claims processing

Accurate billing is a key part of helping patients understand their costs and ensuring your claims process smoothly. We recommend that you:

• Verify benefits prior to appointments, particularly for potentially non-covered or elective services.
• Obtain signed financial agreements for any upgrades or non-covered care.
• Avoid unbundling — bill the procedure as indicated when components are included in the primary service.
• Follow billing requirements specific to Delta Dental PPO™, DeltaCare USA and Delta Dental Premier®.
• Maintain detailed, accurate clinical documentation to support claims.

Understand the Grievances & Appeals process

To help us resolve cases quickly and ensure regulatory compliance, please:

• Confirm that your practice’s contact information with us is current.
• Respond to record requests within 7 calendar days.
• Submit complete documentation to streamline review and improve turnaround times.