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 compliant.
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MA contracted providers and their employees must complete FWA Training annually and within 90 days of hire. This training will help dental office staff understand how to identify and report possible infractions.View Training
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.
The Delta Dental Medicare Advantage Provider Handbook will serve as a useful source of information for you and your office staff.
Interested in joining the network? Simply complete the attached contract to become an in-network provider.
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.
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.
If you would like to join our Medicare Advantage network, please email your request to ORContracting@deltadentalor.com. A member of our Provider Relations team will reach out with next steps.
If you would like to terminate your Medicare Advantage contract, please email your request to ORContracting@deltadentalor.com. A member of our Provider Relations team will reach out with next steps. Please note that contract terminations require 60 days prior notice.
Yes, due to changes in CMS’ guidelines around supplemental benefits, opted-out providers may now be paid for supplemental dental services and may also join our network.
No, joining our network does not result in changes to your direct CMS status. You are also not required to directly opt-in or opt-out with CMS to join the network.
As a participating Medicare Advantage provider, you will be required to treat patients with coverage through any Delta Dental Medicare Advantage plan, including those administered by other Delta Dental member companies. Please refer to the DDOR Medicare Advantage Partnerships section above for a list of MA plans offered in Oregon.
The term “offshore” refers to any country that is not one of the 50 states or U.S. territories. CMS also clarifies that offshore subcontractors includes those who provide services performed by workers located in offshore countries, regardless of whether the workers are employees of American or foreign companies. For example, if your office uses a third-party vendor for patient eligibility and benefits verification and any employees of that vendor are located outside of the United States, the vendor would be considered an offshore contractor.
We understand it can be overwhelming to create and administer a compliance program, so we’re here to help! The American Dental Association has a sample compliance plan available
Yes. Per the Medicare Advantage Network Addendum, participating dental offices must keep records for a period of at least 10 years from the last date of treatment.
The term non-covered service applies to any procedure that is not a part of the patient’s plan benefits. For example, if the patient wanted a dental implant, but implants are not covered under the plan, the member’s signed consent for the service would be needed. Please note that frequency or annual maximum denials do not constitute a non-covered service.
No specific financial waiver is required, however, DDOR has created one in case that’s helpful for your office. You do not need to submit these with your claims, they just need to be in the members file in case they are requested due to an appeal or other kind of review request.
Send dental claims to:
Delta Dental of Oregon
Attn: Dental Claims
PO Box 40384
Portland, OR 97240-0384