Service Area
Perio
Crowns & Build Ups
Out of Country Coverage
Misc. Information
100
If you are quoting "out of service area" benefits, you are quoting what letter benefit on the co-pay schedule?
What is "S" ?
100
D4910, Perio Maintenance may be allowed without prior SRP if the patient is this.
What is Case Type III or higher?
100
A D2790 for Cracked Tooth Syndrome requires this documentation.
What is X-Ray, narrative and chart notes?
100
This number of DDWA groups allow coverage Out of Country.
What is All Groups?
100
A network dentist is not held to their contracted fee with DDWA for this type of benefit.
What is a non covered benefit?
200
A Boeing member in Arizona needs to see a provider participating in this network.
What is any or not at all?
200
When Supportive Therapy is required it must be performed within this time frame.
What is 6 weeks to 6 months prior to treatment?
200
A build up will not be covered within two years of this type of procedure.
What is a Filling?
200
Treatment that is performed Out of Country (OOC) will be covered at this Co-Pay level.
What is Out of Service Area?
200
General Anesthesia, if a covered benefit on the plan, will only be covered with this type of treatment, which varies by group.
What is Qualifying Treatment?
300
If California is inside the service area for a member and they see a Premier provider, what benefit should you quote from the co-pay schedule?
What is the "O" benefit?
300
Arestin, D4381 can be done this many times each benefit period.
What is 2 teeth, per Quad, twice in the benefit period?
300
On a DDPA plan a D2750 will not be covered for a patient under this age.
What is under age 12?
300
DDWA Claims Processors will convert this, when processing the OOC claim.
What is Currency?
300
Deciduous refers to this type of tooth or dentition.
What is baby or primary teeth?
400
A patient is getting a root canal in Costa Rica and DDWA will pay the claim based on this benefit.
What is the "S" benefit?
400
Laser assisted perio therapy (LAPT) is always this.
What is Disallowed so as not to be billable to the patient with a participating provider?
400
A dental office must include this in order to change a crown seat date to another benefit period. Example: D2752
What is chart notes?
400
You may take this information, over the phone, from a member for an OOC claim.
What is any missing information required to process the claim?
400
If the network dentist submits a claim with missing information such as, missing x-ray, tooth number or invalid ADA Code they may not do this.
What is not charge the patient for treatment?
500
The dentist is in the Service Area and Non-Participating. The patient co-pay you should quote is this.
What is "O", Out of Network?
500
A DDPA group will allow SRP, Supportive Therapy to be done a minimum of this many weeks prior to surgery.
What is 4 weeks?
500
The re-cement of a crown, by a different dentist within six months of initial placement is what?
What is Not a Covered Benefit, Patient Responsibility?
500
A DDWA member may submit an OOC claim to this e-mail address.
What is outofcountry@deltadentalwa.com?
500
Overage claim submission may be overridden if the patient has Dual DDWA, the claim was received within the time limit and we only paid on prime and this one other situation.
What is when the claim is not on system, but the dental office (DO) has proof of prior submission?
M
e
n
u