Employer: Frequently asked questions

What changes can I make at open enrollment?

Your company benefits administrator can give you more details and advise you when your company's open enrollment will occur. 

I am divorced. If my former spouse and I both have dental coverage, whose insurance covers our children first? 

The parent named responsible for maintaining insurance would be primary and the other parent would be secondary. If the divorce decree or custodial agreement is silent regarding responsibility, the order of benefit determination is: (1) the plan of the custodial parent; (2) the plan of the spouse of the custodial parent; (3) the plan of the noncustodial parent; (4) the plan of the spouse of the noncustodial parent. If the parents have joint custody, then the parent with the birthday (month/day) earliest in the calendar year usually has primary coverage.

What is an alternate benefit and how does it work? 

In cases where alternative methods of treatment exist, benefits are provided for the least costly professionally accepted treatment. This determination is not intended to reflect negatively on the dentist's treatment plan or to recommend which treatment should be provided. It is a determination of benefits under terms of the patient's coverage. The dentist and patient should decide the course of treatment. If the treatment rendered is other than the one benefitted, the difference between Delta Dental's allowance and the approved amount for the actual treatment rendered is collectable from the patient. 

Can I assign benefits to my dentist?

Dentists who are participating with Delta Dental will automatically have payment assigned to them. If a dentist is not participating with Delta Dental, payment will be sent to the member. Delta Dental will assign benefits to non-participating dentists in New Jersey and in Connecticut under the following circumstances: the plan provides out-of-network benefits, the dental plan is insured, rather than a self-funded plan; and, the patient has properly authorized the assignment of the claim payment. In addition to making sure that the proper authorization appears on the claim form, we may also ask the dentist to submit a W-9 form (required for tax reporting purposes). More information can be obtained by contacting Customer Service or calling 800-452-9310.

What happens when I'm covered by two dental plans (coordination of benefits)?

Having two dental programs (called "dual coverage") does not "double" your coverage. However, it may mean that you will have lower out-of-pocket costs. Usually, one program will be considered primary (usually the one through your job) and the other will be secondary (the one through your spouse's employer). The total payments of both the primary and secondary carrier cannot exceed the total approved amount or the total of what Delta Dental would have paid as primary. As an example, if your dental program covers 80% for fillings, and so does your spouse's, your program would cover the first 80% and your spouse's program would cover the remaining 20%. Some dental benefit plans have "non-duplication of benefits" provisions. This means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist. For example, if both the primary and secondary carrier pay for the service at 80 percent level, but the primary allows $100 and the secondary carrier normally allows $80 for the same treatment, the secondary carrier would not make any additional payment. However, if the primary carrier only pays 50 percent of the dentist’s allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. In this case, the secondary carrier would pay $14 ($80 x 80 percent - $50 = $14).

 

Let Delta Dental of New Jersey and Connecticut make your job a little easier. These FAQs will help you better understand our online billing system and payment process through Billtrust.

Benefits of Electronic Bill Delivery

Online billing provides you with a number of convenient capabilities:

• Email notification when your invoice is available online
• Accessing your invoices and statements online in PDF format
• Downloading your billing information into a variety of accounting packages, including QuickBooks
• Reducing your paper use
• Invoices and payments will be available electronically
• Paper will automatically be turned off upon registration

How will I know my billing is available?
You will receive a summary invoice with a token located in the upper right-hand corner. View a sample of the premium invoice, and view a sample of the claim invoice summary. Using the token, you will go to the billing portal/website noted above the token and register. Once you have registered, you will receive an email notification that your invoices are available with a link to the site.

Where can I find the detailed report?
Because of protected health information (PHI), the detailed report will be available online at Billtrust.

Since the report will now only be online, will it be available in a printable format?
Yes, it will be printable and downloadable into several formats, including PDF and .CSV (for import into Excel).

To whom will you send the invoice, and can I give someone else authority to go into the portal?
It will be sent to the primary contact you provided to us. This contact serves as the administrator for the site and can add additional users with specified privileges. Note: The email only notifies you that a new invoice is ready to be viewed, along with a link to access.

Can I pay online?
Yes, you can schedule a payment online, or enable Autopay.

    The benefits of paying online are:

• Payments are posted within 48 hours
• Pay securely and quickly
• Easily access and track invoice and payment history 24/7
• Enable Autopay to automatically schedule payments
• Receive automatic payment reminders via email ahead of due dates
• Personal information is safer

View our Billtrust banking information setup instructions for additional details on how to setup online banking.

Is my payment account information safe?
We protect your information with the highest level of encryption available. The website is PCI Level 1 Compliant and SSAE 16 Certified. They are the most stringent certifications to ensure your data is secure.

How long will invoices be available online?
Invoices will be available online for one year.

Is this HIPAA compliant?
Yes, this process will not change any of our current HIPAA compliancy.

Can I update or change the enrollment I see online?
To make enrollment or eligibility changes, you should continue to use the Delta Dental of New Jersey or the Delta Dental of Connecticut Online Enrollment secure web portals. Sign in to manage your enrollment. 

Will this affect the enrollment process?
No. Changes in billing will not affect the enrollment process.

Can you show me how online billing works?
Yes, you can view our Invoice Gateway User Guide for additional details on how online billing works.

Whom can I contact if I have questions?

• Email questions to Billing@DeltaDentalNJ.com
• Call us at 1-800-452-9310 and follow the prompts