Delta Dental’s Medicare Advantage membership is growing, and your participation in this network is a great opportunity to increase the number of patients at your dental office. If your dental office is considering joining our Medicare Advantage network or is already participating in this network, you'll need to ensure compliance with the Centers for Medicaid and Medicare Services (CMS) requirements for Medicare Advantage providers. Use this page to connect with the resources you'll need to stay credentialed and compliant.
NOW AVAILABLE! All of your employees must complete our General Compliance and FWA Training annually and within 90 days of hire. This training also includes a cultural competency component to help dental office staff understand and accommodate diverse patient needs.
OIG's LEIE provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other federal health care programs. You should check the list monthly to ensure that new hires and current employees are not on it.
The GSA similarly maintains several exclusion lists, managed through the System for Award Management (SAM). You should routinely check SAM to ensure that excluded individuals and/or entities are not involved in provision of care or services on behalf of your office.
CMS maintains a list of providers and prescribers who are precluded from receiving payment for Medicare Advantage items and services, or Part D drugs furnished or prescribed to Medicare beneficiaries. You will receive an email and letter from CMS/Medicare Administrative Contractors in advance of your inclusion on the preclusion list. The email and letter will be sent to your Provider Enrollment Chain and Ownership System (PECOS) address or National Plan and Provider Enumeration System (NPPES) mailing. The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal. Medicare Advantage plans are required to deny payment for a health care item or service furnished by an individual or entity on the preclusion list. To learn more about the CMS Preclusion List, visit CMS.gov.
To opt-out of the Delta Dental of Kentucky Medicare Advantage Network, send your completed Medicare Advantage Opt-Out Form to medicareadvantage@deltadentalky.com.
Delta Dental is required to monitor and ensure your organization operates in compliance with applicable laws and regulations required by CMS and your Participating Dentist Agreement. Each year, you are required to affirm your commitment to comply with each of the listed topics in the attestation that apply to your organization and the services you provide for Medicare Advantage business.
Complete this form for services provided to the patient that are not covered under the patient's dental plan.
CMS requires disclosure of Medicare Advantage providers’ offshore subcontractor activities. Contracted dental offices (also referred to as first-tier or downstream entities) that subcontract with any offshore entities to process or have access to patient protected health information (PHI) must complete this attestation within 10 calendar days from the date a contract is signed or immediately upon knowledge of this requirement.
An alternative to the traditional Medicare program authorized by Part C of Medicare. Health insurance companies or health maintenance organizations provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program. The Centers of Medicare and Medicaid Services (CMS) oversees the Medicare Advantage Program.
Health benefits coverage under a policy or contract by a Medicare Advantage Organization (MAO) that includes a specific set of health benefits offered to all Medicare beneficiaries residing in a specific service area. Delta Dental contracts with MAOs to administer the dental benefits and network for Medicare beneficiaries.
People 65 and older. About 10,000 baby boomers turn 65 every day in the U.S. Members of a Medicare Advantage Plan (MAP) have the option to purchase supplemental dental coverage.
The fee schedule is the same as your current PPO fee schedule. Submitted claims will process according to the Delta Dental of Kentucky PPO fees.
As a Delta Dental network provider, you already adhere to most credentialing and re-credentialing requirements. The following are a few additional CMS requirements needed to participate in a MAP.
• Exclusion from the Medicare Preclusion List
• Exclusion from the Office of Inspector General List
• Completion of a Compliance Attestation form – must be completed for each location
• Fraud, Waste and Abuse (FWA) training is required annually for office staff. For your convenience, a FWA training program is available on this page.
• Non-Covered Services - Providers are required to have signed written documentation indicating the member understood and agreed to pay for any non-covered services. A sample non-covered services form is available on this website.
• Directory Accuracy Confirmation - CMS requires Delta Dental to send quarterly audit letters to dentists verifying the information in the directory is correct and up-to-date.
• Members must receive treatment from a MAP network provider to receive benefits.
Delta Dental is required to monitor and ensure your organization operates in compliance with applicable laws and regulations required by CMS and your Participating Dentist Agreement. Each year, you are required to affirm your commitment to comply with each of the listed topics in the attestation that apply to your organization and the services you provide for Medicare Advantage business. The compliance attestation form is available on this website. A compliance form must be completed for each location.
You will receive an email and letter from CMS/Medicare Administrative Contractors in advance of your inclusion on the preclusion list. The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal. For more information, visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Preclusion-List.
On a monthly basis you need to check the Office of Inspector General’s (OIG) List of Excluded Individual and Entities (LEIE) and the General Service Administration’s (GSA) System for Award Management (SAM) database to make sure dental providers and staff inyour office do not appear on any government preclusion/exclusion lists that would prevent your practice from participating in the Medicare Advantage network.
Yes. Network participation works the same way as it does today with Delta Dental PPO national participation. You are a MAP network provider when treating patients that have coverage in a MAP administered through another Delta Dental Plan.
Yes. If you currently receive EFT, you will also receive MAP payments electronically.
Eligibility and benefits are available on the Dental Office Toolkit. The same toolkit features are available for the MAP including online claim submission and electronic deposit information.
To prepare for those partnerships with local MAOs, we must take the first step in building a strong network. In the meantime, Medicare Advantage providers may treat patients located in Kentucky that have coverage through another Delta Dental Medicare Advantage Plan.
Since this is a Supplement to your Delta Dental PPO Participating Dentist Agreement, it is simple, just one!
Return the completed compliance attestation form (found on this page) for each location to medicareadvantage@deltadentalky.com or fax to 877-224-2441.
Keep the Medicare Advantage Supplement with your current Delta Dental PPO Participating Dentist Agreement.
We are here to help!
Call
Fax
877-224-2441
Delta Dental of Kentucky
ATTN: Provider Relations
PO Box 242810
Louisville, KY 40224
