Applies to:

Individual Medicare Advantage plans 

Participating Delta Dental provider billing

A participating provider is a dentist located in Michigan, Indiana or Ohio who is part of the Delta Dental Medicare Advantage PPO and/or Medicare Advantage Premier network for all Priority Health Medicare Advantage plans, except PriorityMedicare D-SNP which uses Delta Dental Medicare Advantage PPO providers only. All other dentists are considered out-of-network (non-participating) providers.

Participating dentists agree not to charge patients more than the maximum approved fee for a covered service.

Submit claims directly to Delta Dental for payment within one year of the date the services were completed.

Delta Dental has 30 days from the date of receiving a claim to determine payment or notify you if they need additional information. The notice will:

• Describe and explain why the additional information is needed
• Request an extension of time in which to determine the claim
• Inform you that the information must be received within 45 days or your claim will be denied.

If you do not supply the requested information, Delta Dental will deny the claim.

Once Delta Dental receives the requested information, it has 15 days to make a final decision on the claim, and 5 days after the decision to notify you.

Delta Dental of Michigan will send payment directly to participating dentists.

The member is responsible for incurred charges after plan allowances as outlined in the member certificate.

Non-Delta Dental provider billing

If you are a non-participating dentist (defined as a dentist who is NOT part of the Delta DentalMedicare Advantage PPO or Medicare Advantage Premier network in Michigan, Indiana or Ohio for all plans), you will be paid the non-participating dentist's fee for covered services. If you charge more for a service than the rate Delta Dental has agreed to pay, the member will be responsible for paying the difference.

You must participate with Medicare to be reimbursed.

Submit claims directly to Delta Dental for payment. The process for determining claims is the same as for participating providers, above.

Delta Dental usually sends payments to the member, and then the member is responsible for making full payment to the dentist. The member is responsible for any difference between the Delta Dental payment and the amount the dentist submitted.

• Out-of-network claims form

Send to:

Delta Dental
P.O. Box 9298
Farmington Hills, MI 48333-9298

Join a Delta Dental Medicare Advantage Plan network

We encourage all providers to contract with Delta Dental Plan of Michigan so the member will receive the best rates for their dental services. Sign an agreement with the Delta Dental Plan of Michigan to participate in the Delta Dental Medicare Advantage PPO network and/or Delta Dental Medicare Advantage Premier network. 

Go to deltadentalmi.com to join the network.