A claim submitted to Delta Dental of New Jersey must accurately reflect the date when the service or procedure was actually performed. For many services or procedures, that date is the date of the patient’s visit. For other services or procedures—for example, multi-stage services such as crowns—Delta Dental of New Jersey requires the claim to reflect the completion date as the date that the procedure or service was actually performed.
Sometimes, offices submit claims that contain inaccurate dates. Inaccurate dates may be the result of an offices internal policy. For example, an office may report the date of service for root canal therapy as the start date rather than the end date of the procedure. Or, it may report the preparation date rather than the cementation date as the date of service for a crown. Regardless, Delta Dental requires the claim to reflect the completion date of the service or procedure.
Keep in mind, for example, that for removable prosthetic appliances, the completion date is the date of insertion. For immediate dentures, the completion date is the date the remaining teeth are removed and the denture is inserted. For fixed partial dentures and crowns, onlays, and inlays, the completion date is the cementation date, regardless of the type of cement utilized. For root canal therapy, the completion date is the date the canals are permanently filled.
Inaccurate reporting of dates of service can not only result in overpayments that must be returned, but also loss of participation status and/or other undesirable consequences.
More information is available at:
- New Jersey Board of Dentistry, Administrative Code, N.J.A.C. 13:30-8.10
- Connecticut General Statutes, Title20, Chapter 379, Section 20-114
- Delta Dental of New Jersey Participation Agreement
- Delta Dental of New Jersey Dentist Handbook for Participating Dentists, Chapter 4, Form Completion and Chapter 11, Claim Verifications
To report any suspected fraud to Delta Dental of New Jersey:
- Call our fraud hotline: (888) 696-3262
- Email: reportfraud@deltadentalnj.com
- Fax: (973) 944-4573
Write to:
Delta Dental of New Jersey
Special Investigations Unit
1639 Route 10
Parsippany, NJ 07054
