Delta Dental of New Jersey
Dental
News
N OV E M B E R 2 0 1 4
Delta Dental Offering Policies on 2015 Insurance Exchange
Delta Dental of New Jersey will begin offering individual pediatric and adult dental
benefits policies on the Federal Exchange in New Jersey in 2015. Small group plans,
which include the essential pediatric dental benefits, will also be available outside of the
Federal Exchange either through brokers or directly. In Connecticut, we will continue to
administer pediatric dental benefits embedded in a health insurance product offered by
HealthyCT. Open enrollment on the exchanges will begin around November 15. Note
Important Reminder for
Connecticut Orthodontists
If your practice is submitting cases
to Delta Dental of New Jersey for a
HealthyCT patient or for any patient
that these plans include procedures which require mandatory pre-authorization. Failure to
that is covered by a Delta Dental of
submit a pre-authorization can result in a service being disallowed or denied. Coverage
New Jersey plan which includes the
goes into effect January 1, 2015 for plan selections made by December 15.
essential pediatric dental benefit for
For more about the Affordable Care Act and dental, read Chapter 20 in your
children less than 19 years of age
Participating Dentist Handbook. To access the Handbook, go to www.deltadentalnj.com.
related to the Affordable Care Act,
Log onto Benefits Connection and click “Participating Handbook” under “Other Tools.”
you must first prior authorize the
To access the Federal Exchange, go to www.healthcare.gov. To access HealthyCT, go to
www.healthyct.org.
treatment plan and submit supporting diagnostics. In Connecticut, this
would include the Saltzman Scale,
Pediatric Dental Essential Health Benefits Reminder
and in New Jersey, it would include
Pediatric dental benefits for children under age 19 are among the 10 Essential Health
the NJ-Mod2 document. If services
Benefits (EHBs) mandated by the Affordable Care Act. Pediatric dental EHB plans
are not pre-authorized, benefits may
differ from traditional dental plans in the following ways:
be disallowed.
•
•
•
No annual or lifetime dollar maximums on benefits
the New Jersey Orthodontic
•
mark plan is the NJ FamilyCare CHIP plan; Connecticut’s is the “HUSKY B” CHIP plan.)
Limitations and exclusions are based on the CHIP plan and are different in many
Evaluation HLD (NJ-Mod2)
aspects from the Delta Dental benefits you are accustomed to under most of our plans
Assessment Form and the
Some plans consider the “network” as the Delta Dental PPO, as well as participating
Connecticut Saltzmann
specialists. While benefits are generally available if services are received from den-
Handicapping Malocclusion
•
Annual out-of-pocket dollar limits
Benefits based on the benchmark plan selected by the state. (New Jersey’s bench-
tists in the Delta Dental Premier network or from non-participating dentists, the annu-
•
•
al out-of-pocket dollar limits do not apply.
Orthodontic coverage is approved only if “medically necessary”
Certain services require mandatory prior authorization to receive coverage
For more about EHB orthodontic coverage and mandatory prior authorization require-
ments, go to www.deltadentalnj.com. Click “Dentists,” then the “Forms” link under
“Resources.” Scroll down and find the appropriate links under “Claims.”
For more about which services
require prior authorization, including
Assessment Record, go to
www.deltadentalnj.com/dentists/
forms_dental_resources.html, and
scroll down to “Claims.”
Dental News 2
Upcoming Changes to Clinical Requirements for
Non-Surgical Periodontal Treatment
On Our Website
As of January 1, 2015, the clinical criteria for scaling and root planing (D4341 or
Delta Dental Website
D4342) have been updated. In addition to the existing documentation requirement
Go to www.deltadentalnj.com
that demonstrates periodontal charting with generalized 4 millimeter pocket depths,
Dentist Portal
submission of a full mouth set of radiographs taken within the past 12 months that
are of diagnostic quality and which demonstrates a loss of alveolar crest height
beyond the normal 1.0–1.5 millimeter distance to the cemento-enamel junction
(CEJ) will now be required in order for benefits to be considered as payable for this
procedure. Panoramic radiographs, with or without bitewing films, will not be accepted to support a claim for periodontal treatment.
Direct Deposit: The More You Know, the More You’ll Want to Say “Yes”
Are you a practicing dentist in the United States? Do you submit claims to Delta
Click “Dentists” on the top
navigation bar
Videos
Click this icon on the right side
of any screen
Dental News
Dental of New Jersey? If so, your practice can save time, improve cash flow, and
reduce the risk of lost or stolen checks by using direct deposit for your claims payments. When you enroll in direct deposit with Delta Dental of New Jersey, we automatically deposit claims payments directly into your bank account. Worried about
how to track payments made by direct deposit? You can go paperless and receive
EOB notifications by email (although EOBs by mail also are still available). Also, if
your practice submits claims through a clearinghouse, you may be able to receive
835/Electronic Remittance Advice (ERA) claim payment information electronically
(check with your clearinghouse for more information). With direct deposit, you have
nothing to lose—except the line at the bank.
For more about direct deposit with Delta Dental of New Jersey, or to enroll, go to
www.deltadentalnj.com/dentists/eft_enrollment.html.
On Video: Wisdom Teeth and Infection
Dr. Keith Libou, Chief Clinical Officer at Delta Dental of New Jersey, shares the smart
way to handle an infected wisdom tooth in a recent Dental Connections video.
A publication of
Delta Dental of New Jersey, Inc.
Comments and suggestions are
welcomed and should be directed to:
Corporate Communications Dept.
Delta Dental of New Jersey, Inc.
P.O. Box 222
Parsippany, NJ 07054-0222
www.deltadentalnj.com
In Connecticut, Delta Dental Insurance
Company writes dental coverage on an
insured basis and Delta Dental of New
Jersey administers self-funded dental
benefit programs.
Connect with Us
To view this and other Dental Connection videos, visit our website at
www.deltadentalnj.com. Click the “Dental Connections” link under “Site Updates.”
ADDRESS SERVICE REQUESTED
Delta Dental Plaza
1639 Route 10
Parsippany, NJ 07054
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