Delta Dental Credentialing and Provider Application

Delta Dental credentialing is the application dentists ask about most, for the obvious reason: in many markets Delta holds more of the commercially insured population than any other dental carrier. Joining is often the right decision. It is not automatically the right decision, and the tier you join on matters as much as whether you join at all.

For the work itself, see our dental credentialing services.

Delta Dental is not one company

Delta Dental provider credentialing is handled locally. Like Blue Cross Blue Shield, Delta Dental is an association of independent member companies, each operating in its own state or group of states. That means:

• You apply to the member company for your state, not to a national office.
• Forms, portals, processing times and fee schedules differ between member companies.
• A practice with locations in two states may need two applications.
• Out-of-state Delta members are generally still covered when they visit you, settled between the member companies, similar in principle to BlueCard.

The tier decision: PPO and Premier

We map the offered fee schedule against your top 25 CDT codes by production, so you see the real discount on the procedures you actually perform rather than a headline percentage.

The application

The ADA Credentialing Service

The ADA Credentialing Service is built on the CAQH platform and is available to ADA members at no cost. Many dental plans, Delta included, will accept credentials from it. Whichever route you use, the profile has to be complete and re-attested every 120 days: a lapsed attestation quietly stalls every application you have in flight.

Associate dentists

An associate joining a practice that already participates still needs their own credentialing with Delta, but is normally linked to the practice's existing agreement rather than contracted separately. Linking is faster, but it is a different form, and filing a full application instead typically costs 60 days during which the associate's production is not billable as in network.

Start 90 to 120 days before the associate's first day. It is the most useful sentence on this page.

Ownership, location and TIN changes

Re-credentialing is triggered by more than the routine cycle: buying or selling a practice, a change in ownership percentages, a new tax ID, a new or relocated office, and a change of practice name or remittance address. Filing late is one of the few things that can suspend payment on an otherwise healthy agreement.

Work out which member company you are applying to

The first step in Delta Dental credentialing is identifying the right company, and the branding actively hides it. Delta Dental is a group of separate member companies, each licensed for its own state or states, each with its own application, its own timeline and its own fee schedule.

You apply to the member company for the state your practice is in. That has a few consequences:

• Two offices in two states means two applications to two companies. Being credentialed by one gives you nothing with the other.
• Fee schedules differ by state, sometimes substantially, so what a colleague in another state tells you they are paid is not a guide to what you will be paid.
• Patients arrive with cards from every state. You can treat a member whose plan is administered elsewhere, and your participation status is still decided by your own state's member company.

Ask, in writing, which member company holds your application and get a reference number for it. Dental practices lose weeks chasing the wrong office.

The tier decision is a long contract

Delta Dental runs two networks and they pay differently. This is the single most consequential decision in the whole application, and the form presents it as a tick box.

• Delta Dental PPOThe lower fee schedule, and the one most employer plans steer patients towards. Patients pay less out of pocket when they see a PPO dentist, so the volume tends to follow it.
• Delta Dental PremierThe higher fee schedule, and an older and broader network. Patients using a Premier dentist generally pay more than they would at a PPO office.

A practice can join one or both. Joining both means accepting the PPO fee schedule for PPO patients, and for most offices the majority of Delta patients turn out to be PPO.

Run the arithmetic before you sign rather than after. Take your top twenty five CDT codes, put your current collected amount next to the offered PPO fee and the offered Premier fee, and weight them by how often you actually perform each one. A ten percent difference on a code you do twice a year does not matter. The same difference on prophylaxis, exams and radiographs decides whether the contract works.

Leaving a network later is possible but it is not quick, and patients who chose you because you were in network do not always follow you out.

Associates: link them, do not re-credential them

The most common mistake in a dental group is treating a new associate as a brand new application. In most cases the associate is being added to a practice that already holds the contract, and there is a shorter route for that.

Getting this wrong costs months. A full application for a dentist who only needed linking to an existing location can take three or four times as long, and until it completes the associate cannot be billed as participating.

What to do instead:

1. Start before the associate's first day, not after it. Six to eight weeks ahead is not too early.
2. Ask the member company specifically whether this is a link to an existing location or a new credentialing application. Use both words; the answer changes the form.
3. Ask, at the same time, whether the effective date can be backdated to the start date and what evidence they need for that. Some will, some will not, and it is much easier to ask before than to appeal after.

Billing an associate's work under the owner's number while waiting is not a workaround. It is the kind of thing that turns into an audit and a refund demand, and it is worth saying plainly to whoever suggests it.

CAQH or the ADA service, and keeping it current

Dentists have two ways to hold a credentialing profile, and Delta member companies generally accept either. What matters more than which one you choose is that it stays current.

Attestation expires every 120 days. It is a confirmation that what is on file is still true and it takes minutes, but when it lapses the profile reads as out of date, the member company cannot pull it, and the application stops without anybody telling you. Documents inside the profile matter just as much: an expired malpractice certificate blocks the pull exactly like a lapsed attestation does.

The member company also has to be authorized to see your profile. A complete profile with no authorization is invisible to the plan you are applying to.

After you are in, two things continue. Provider directory details have to be verified regularly under federal rules, and ignoring those requests can get you suppressed from the directory that patients search. Re-credentialing then comes round every few years and is mostly a re-check of the profile, which is painless if it has been maintained and a fresh application if it has not.

Delta Dental recredentialing

Delta Dental re-credentials participating dentists on a regular cycle, typically every three years. It re-checks your license, malpractice cover and sanctions, mostly from the CAQH or ADA profile you already keep.

The risk is a request that arrives at an old address or a departed office manager's inbox. Miss the deadline and participation can end, and rejoining means a new application. Keep the member company's records up to date whenever your address, email or ownership changes.

For the whole dental payer mix, see our dental credentialing services.

Related

• CredentialingDental credentialing services all dental PPOs, associate linking and fee schedule review
• ClaimsDental billing services CDT coding, attachments and PPO write-off tracking