Pre-Treatment Estimates

Use Provider Tools to avoid surprises with a free, real-time pre-treatment estimate.

Before you start treatment, log in to your online account and use the Submit Claim or My Patients tools to request a pre-treatment estimate. Pre-treatment estimates often process within moments (when clinical review isn’t required), so you can talk with your patients about treatment plans while they are still in your office. Pre-treatment estimates tell you about:

• Contractual limitations or exclusions that apply to your treatment plan
• Delta Dental’s estimated payment amount
• The patient’s estimated payment portion

Advantages

• Determine how best to plan treatment; for example, treatment may be done in segments, over weeks, months or years, to incorporate all available benefits
• Develop a payment plan for the patient, taking into account what Delta Dental is expected to pay
• Receive email notifications when new documents are available to review online (when you sign up to discontinue paper documents).

When to Request a Pre-Treatment Estimate

• Expensive or extensive treatment is being considered
• Dental plan annual maximum, limitations and/or exclusions may affect coverage

How to Request a Real-Time Pre-Treatment Estimate

Log in to (or register for) your Online Services account.

From the Provider Tools screen, select the My Patients tool or the Submit Claim tool.

To use My Patients:

• First, select the patient. Then, select the Submit Claim icon under Actions.
• Next, under Type of Transaction, choose Pre-Treatment Estimate.
• Complete the claim information, click Continue, then Submit Claim.

To use Submit Claim:

• Enter your patient’s name and choose Existing (or enter a new patient’s information).
• Select the patient, then select the Submit Claim icon under Actions.
• Next, under Type of Transaction, choose Pre-Treatment Estimate.
• Complete the claim information, click Continue, then Submit Claim.

Use the My Claims tool to see Delta Dental’s estimated payment and the patient’s portion (often within moments when clinical review is not necessary).

Or, you may mail a paper claim to Delta Dental. Include all required x-rays, documentation and/or written narratives. You will receive by mail a pre-treatment estimate showing the amount Delta Dental is estimated to pay and the amount of the patient’s responsibility. Unfortunately, we cannot provide pre-treatment estimates by telephone.

Limitations

Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patient’s:

• Eligibility (until the date of service)
• Incentive levels
• Maximum or deductible
• Any additional coverage that may apply

At any time, you can review the patient’s current eligibility and benefits information, including remaining maximum and deductible amounts. Simply log in to your Online Services account (or register if you have not already done so) and use the Eligibility and Benefits tool.

When the services are complete and a claim is received for payment, Delta Dental will calculate its payment based on the enrollee’s current eligibility, amount remaining in his/her annual maximum and any deductible requirements.

How to Submit a Claim for Payment

When the services are completed, log in to Online Services and use the My Patients tool or the Submit Claim tool to transmit a new free, real-time claim for payment.

Or, transmit a claim via a clearinghouse, or complete and mail a paper claim to the Delta Dental company through which the patient has coverage.

• Include on the claim only the services that were provided (omit services that weren’t provided, even if they were part of the original pre-treatment estimate)
• Include any additional services that were provided
• Submit the claim to Delta Dental as soon as possible after the services are completed (in all cases, submit claims not more than six months after the date of service)

We will process the new claim for payment using the current eligibility and benefits provisions.