Participating dentists shall not submit any claims to Delta Dental for services performed by dentists who are not participating dentists with Delta Dental on the date(s) when the services were performed. In order to receive direct payment as a participating dentist, every dentist in a dental practice must sign a participating dentist agreement and credential with Delta Dental as a participating dentist. The claim form cannot misstate the identity of the treating dentist.
Participating dentists shall file their “usual” fees as defined in the Bylaws of Delta Dental of New Jersey, Inc. “Usual” fee is the fee that the dentist most frequently actually charges to and collects from his/her uninsured (i.e. - private or uninsured) patients as payment in full, less any discount which is regularly offered to patients, other than a discount which reasonably reflects the time value of money (i.e. where the amount of the discount is essentially the same as the amount of interest that the dentist would reasonably expect to earn by receiving the payment on an accelerated basis). For purposes of this regulation “uninsured” means without dental coverage, but exclusive of patients covered by governmental assistance programs such as Medicaid.
Patient discounts are considered acceptable as long as the discount or any waiver of copayment responsibility is noted on the claim form. If you are giving a discount, it should be applied to the fee for the service rendered so that the net fee submitted to Delta Dental and the net fee charged to the patient are both reduced. The discounted fees must be specified on claims submitted for payment.