I am so happy to have found you! Log in to Provider Tools and select EFT and ERA to get started. For other Delta Dental member companies, please check how they prefer to register your NPI. All emails are encrypted in our system to ensure your private information is secure. 877-585-8480. services@myperformancehlth.com. PO Box 1809 Need to submit transactions to this insurance carrier? ), Once you have received your Submitter ID and password from CDPHP, please call the Claimshuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to CDPHP, 835Electronic Remittance Advice Enrollment Request, JF Noridian Administrative Services: Alaska Medicare, JF Noridian Administrative Services: Arizona Medicare, JH Novitas Solutions, Inc: Arkansas Medicare, JE Noridian Administrative Services: California Medicare, Blue Shield of California (Anthem Central) via Availity, JH Novitas Solutions, Inc: Colorado Medicare, Colorado Blue Cross Blue Shield (Anthem Central) via Availity, Connecticut Blue Cross Blue Shield (Anthem Central) via Availity, JL Novitas Solutions, Inc: Delaware Medicare, Blue Cross Blue Shield of Washington D.C. (Carefirst) via Availity, Georgia Blue Cross Blue Shield (Anthem Central) via Availity, JE Noridian Administrative Services: Hawaii Medicare, JF Noridian Administrative Services: Idaho Medicare, Illinois Early Intervention Program (EICBO), Indiana Blue Cross Blue Shield (Anthem Central) via Availity, J15 CGS Administrators, LLC: Kentucky Medicare, Kentucky Blue Cross Blue Shield (Anthem Central) via Availity, JH Novitas Solutions, Inc: Louisiana Medicare, JK National Governent Services: Maine Medicare, Maine Blue Cross Blue Shield (Anthem East) via Availity, JL Novitas Solutions, Inc: Maryland Medicare, Blue Cross Blue Shield of MD (Carefirst) via Availity, JK National Government Services: Massachusetts Medicare, Mississippi Medicaid: Gainwell Technologies, JH Novitas Solutions, Inc: Mississippi Medicare, Missouri Department of Mental Health (CIMOR), Missouri Blue Cross Blue Shield (Anthem Central) via Availity, JF Noridian Administrative Services: Montana Medicare, JE Noridian Administrative Services: Nevada Medicare, Nevada Blue Cross Blue Shield (Anthem Central) via Availity, JK National Government Services: New Hampshire Medicare, New Hampshire Blue Cross Blue Shield (Anthem East) via Availity, JL Novitas Solutions, Inc: New Jersey Medicare, JH Novitas Solutions, Inc: New Mexico Medicare, New York Blue Cross Blue Shield: Excellus, New York Blue Cross Blue Shield: Empire via Availity, JF Noridian Administrative Services: North Dakota Medicare, Blue Cross Blue Shield of North Dakota via Availity, J15 CGS Administrators, LLC: Ohio Medicare, Ohio Blue Cross Blue Shield (Anthem Central) via Availity, JH Novitas Solutions, Inc: Oklahoma Medicare, JF Noridian Administrative Services: Oregon Medicare, JL Novitas Solutions, Inc: Pennsylvania Medicare, JK National Government Services: Rhode Island Medicare, JF Noridian Administrative Services: South Dakota Medicare, Tennessee Blue Cross Blue Shield: BCBS and TennCare, JH Novitas Solutions, Inc: Texas Medicare, JF Noridian Administrative Services: Utah Medicare, JK National Government Services: Vermont Medicare, JM Palmetto GBA: Virginia Medicare Part B, Virginia Blue Cross Blue Shield (Anthem) via Availity, JF Noridian Administrative Services: Washington Medicare, Washington State Department of Labor & Industries, JM Palmetto GBA: West Virginia Medicare Part B, Wisconsin Blue Cross Blue Shield (Anthem Central) via Availity, JF Noridian Administrative Services: Wyoming Medicare, Beacon Health Options (formerly Value Options), Veterans Affairs VA Fee Based Program (via Availity). When Delta Dental of California is the secondary carrier and is subject to the provisions of the California Health and Safety Code 1374.19, we pay the lesser of: (1) the amount we would have paid in the absence of any other dental benefit coverage; or (2) the member's out-of-pocket cost payable under the primary plan for benefits that are covered by the secondary plan. Tech was very helpful, very patient and very professional. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. Be able to stand alone, providing sufficient data for each service date to support the medical decision making and diagnoses codes billed. 1-866-693-4611. All Rights Reserved | Capital District Physicians' Health Plan, Inc. | 500 Patroon . The companies have agreed to contact members who filed claims for health care services to make sure they received proper denial notices. . Very satisifed with the service. D4210-D4212, D4240-D4245, D4260-D4285, D4341-D4342, D4381, Description of service: Maximum contract allowances will differ by 5-digit ZIP code. 24 hours a day, 7 days per week. Two jobs or two retiree plans: The plan that has covered the employee longest is primary. D4210-D4212, D4240-D4245, D4260-D4285, D4341-D4342, D4381. 2022 CDPHP. Processing will take approximately two weeks from the date of receipt. Implant supported prosthetics, Description of service: You will be notified separately when processing of secondary coverage is completed. Get the latest health news in your inbox. )After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. (Note: Fee filings are not used in Texas or by any states administered by Delta Dental of Pennsylvania.). Section 3. Description of service: Example:If the dentist submits a fee on a claim for $120, and the maximum contract allowance is $100, Delta Dental will calculate its payment and the patients payment based on $100. how to upgrade globalprotect client; russian population in philadelphia; breakaway chords with capo; susan clarke obituary; train from boston to charleston, sc You can ask the patient to advise us by calling our Customer Service department, or you can send a copy of the notice from the patients former carrier that includes this information. All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI. Last Name*. Enter your patients name and choose Existing (or enter a new patients information). Do you use the Internet to obtain eligibility and benefits information or check on the status of claims? However, some health plans may choose to require NPIs on all transactions. This website is the home of Delta Dental of California; Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; Delta Dental of West Virginia, Inc. and their affiliated companies. Create Account. Get Henderson Jennifers Contact Info Use your FastAttach connection, a service available through NEA, to electronically transmit digitizedx-rays, narratives, intra-oral pictures, Explanation of Benefits (EOB) Statements or any other document needed to adjudicate the claim. Include the amount paid by the previous carrier on the claim. Performance Health. Claims at Cdphp. The NPI Enumerator will help you with your NPI application and to update your information in the NPPES. Learn more about our payments optimization platform. To contact Customer Care, please call the phone number on the back of your Member ID Card. It is very important that you complete and return the entire enrollment packet as described above. Also, medical coverage would be primary if the group dental plan contract indicates that specific oral procedures are covered (such as a biopsy, oral surgery provided by a physician or dental treatment provided in a hospital). Box 1171 Milwaukee, WI 53201 (Paper Claims) EDI Payer ID #62777 (Electronic Claims) Sample ID Card (Front): Sample ID Card (Back): Payer: Allied Benefits (National General Benefit Solutions) When premiums increase, groups may consider dropping dental benefits altogether. It is simply a random number that does not expire. We update them regularly, usually every 6 to 24 months. If you live in an area without 911 services, contact your local emergency, medical or police service. Mailing addresses for your AARP Dental Insurance Plan claims. The patient is responsible for their coinsurance/copayment portion only. Susie Doran Carter, Westcare Management, Inc.LTC Medicare Consultant and Billing ServiceSalem, OR. Copyright 2013 AXIOM Systems, Inc. All Rights Reserved. Periapical radiographs pre- and post-operative, Chart notes including periodontal case type and diagnosis, Narrative including necessity of treatment and mobility of teeth, Periapical or bitewing radiographs documenting bone loss, Narrative including necessity of treatment, Periapical or panoramic radiographs - current, Narrative including diagnosis, orthodontia type, and treatment length, Narrative for any exceptional cases and/or unspecified codes in all categories of service (D##99). To expedite the processing of your claim, utilize the requirements below to identify the necessary documentation and/or clinical information required for review of specific procedure codes. If you need to speak with the California Department of Public Health duty officer relating to a situation which poses an immediate health risk, please call (916) 328-3605 please call the CDPHP provider . Unscheduled dressing change, Procedure codes: Dentists are encouraged to seek their own legal advice about how the NPI pertains to their practices and circumstances. Its important to keep in mind, then, that each progress note in the medical record must: Additional tips for ensuring proper documentation and diagnostic coding are detailed in the chart below. In a few minutes, you'll be able to: View payments . Thanks for your honesty and integrity! It was simple for our staff to learn and it integrated easily with our accounting/billing program. Before you start treatment, log in to your Provider Tools account and use the Submit Claim or My Patients tools to request a pre-treatment estimate. A patient may have dual coverage through the same Delta Dental company (for example, your patient may have her own Delta Dental of California coverage and also be covered as a spouse through her husbands plan, which is also a Delta Dental of California plan). Alpharetta, GA 30023. Dual coverage with the same Delta Dental company, California rule for coordination of benefits, How to request a real-time pre-treatment estimate, What to include on an orthodontics treatment claim. Primary coverage: natural parent the child lives with, Second: natural parents spouse/domestic partner, Fourth: non-custodial natural parents spouse/domestic partner, Contractual limitations or exclusions that apply to your treatment plan, Determine how best to plan treatment; for example, treatment may be done in segments, over weeks, months or years, to incorporate all available benefits, Develop a payment plan for the patient, taking into account what Delta Dental is expected to pay, Receive email notifications when new documents are available to review online (when you. Please call our Member Services Department. It has been especially nice to know that the Axiom staff is there when Medicare changes something and they are right on it. Code for coexisting conditions when documentation indicates that the condition affects the care, treatment, or management of the patient. I am a very small company, and have actually now reduced my overhead by going with you guys! We can now process 276/277 requests (claim status). Excellent service and I never give anyone "Excellent" scores on surveys. CalPERS (California Public Employees Retirement System) . Hotlines to help you get specific help quickly (to report fraud, for example) Resources to help you find specialty care (chemical dependency services, etc.) To be sure, please refer to your dentist handbook. Privacy Practices; Terms of Use; Privacy Policy; Customer Support 2022 CDPHP. A most unexpected experience: Someone who knows and is helpful. (Remember that mailing time can take as much as five days. Copy of lab bill. However, if the primary carrier only pays 50% of the dentists allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. This is important because some services may be included in the patients basic coverage, even if the patient does not have specific orthodontic coverage. Your customer support reps are the best!!! If you answer yes to any one of the following questions, you are considered a covered entity under the NPI standard and are required by federal law to obtain an NPI. With electronic claims submission, your claims are automatically edited for missing or invalid information before they are sent to carriers. Start quoting dental + vision plans for small business. Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patients: At any time, you can review the patients current eligibility and benefits information, including remaining maximum and deductible amounts. I always get the most fabulous service when calling or emailing!!! Delta Dental. For Individual & Family plans, 1-855-672-2788. Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah and U.S. Virgin Islands: E-mail:ProfessionalServices@ddic.delta.org Once you submit your claim adjustment request, it can take up to 21 calendar days for it to process. The SolAce product is very user friendly and affordable. Locate your processed claims by entering your claim number and selecting "Search.". Once you have received your Submitter ID and password from CDPHP, please call the Claimshuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to CDPHPPlease have 25 test claims ready for testing. Every time I call, it feels as if I am talking directly with the owner of the company. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). Patients may change their coverage, usually in the fall or spring, during their open enrollment periods. . All fields required unless otherwise noted. Unfortunately, we cannot provide pre-treatment estimates by telephone. Who is Oscar? For more information about electronic encounter form submission, please email ourEncounters department. Learn more about the BlueCard Program. Step 1 - Tell us about yourself. . Endodontics. Leave the next line blank. Mechanicsburg, PA 17055. Youll see Delta Dentals payment and the patient portion when the claim or pre-treatment estimate processes, often within moments (when clinical review is not necessary). Allowances will differ depending on the type of plan. I can't tell you how wonderful it is to work with your agency. Use these tips for clear, complete paper claims that will move smoothly through our system. Periodontics (including scaling and root planing), Description of service: You can submit a request for a claimadjustment. Contact Us. SolAce has been a valuable tool that has been a life saver for my billing service for years. Then, select the Submit Claim icon under Actions. Using correction fluid or a highlighter pen. D3310-D3330, D3921. Essentially, if a condition is not appropriately documented in a patients medical record, for all intents and purposes, it is deemed to be nonexistent. Required Documents for those applying for new Submitter IDs. The CDPHP Difference . Payments Optimization for Providers. The online MFA process uses your login credentials plus an additional source (email, phone/voice, text, or authenticator app) for supporting "evidence" of your identity before granting access to your member account. CDPHP requires MFA as an extra security check to make sure your information stays safe. Have never had any problems and this is the easiest claim site. Coverage received as an active employee is primary. Please dont send claims for monthly orthodontic visits. For Other constituents, please fill-out the form below: I am a*. Once the complete provider enrollment packet has been received, the documents will be processed. If this is a transaction you would like to utilize please make sure to enroll with the payer. Pre-treatment estimates are especially beneficial when expensive or extensive treatment is being considered and/or dental plan annual maximum, limitations and/or exclusions may affect coverage. Once the complete provider enrollment packet has been received, the documents will be processed. Oral surgery (biopsy), Procedure codes: Address: City:State:ZIP: Phone: Email: FSA EXPENSE CLAIM FORM . Search claims and view status . Photocopied claims that are blurred or skewed. - Easily check coverage for health care services - Quickly see claims that have been . Video. A medical plan may be primary when an accident has caused the need for dental treatment (such as a broken tooth resulting from a fall or a car accident). Child Health Plus Information Line: 1-800-698-4543. This helps ensure that you dont contribute to higher costs that can potentially jeopardize patients dental benefits plans. Stray marks in spaces that should be left blank. CDPHP requires MFA as an extra security check to make sure your information stays safe. Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. Chart notes including periodontal case type and diagnosis. By mail CVS Caremark Customer Care Correspondence PO Box 6590 Lee's Summit, MO 64064-6590 Once the complete provider enrollment packet has been received, the documents will be processed. Saving money by eliminating printing, copying and mailing costs. Box 272630 Chico, CA 95927-2630 Phone:(800) 622-0632. Sign in. First, select the patient. ), Birth date for the patient and eachmember, If parents are divorced, the parent with whom the child lives, When Delta Dental is the secondary carrier, Explanation of Benefits (EOB) from the primary carrier. If you enter two NPIs (one for the treating dentist and another for the billing entity), please verify that they are both valid. Our billers love the interface that ClaimShuttle provides and I would be happy to be a future reference if needed. In joint custody cases, the parent This time it was warranted. Once you have received your Submitter ID and password from CDPHP, please call the SolAce Support Team and set an appointment for a Mailbox setup and Test Transmission to CDPHPPlease have 25 test claims ready for testing. Crown lengthening, Description of service: Box 3877 Church Street Station New York, NY 10008- 3877 *New York All Excellus plans use this mailing address: Excellus BCBS Attn: Claims She knew of the issue quickly and stayed at hand until issue was resolved. This causes the dental carrier to cover the patient's share of the fee. First Name*. Secondary Claims. If this is a transaction you would like to utilize please make sure to enroll with the payer. Questions about our plans? Document exceptional or unusual circumstances only in the Remarks or Comments field of the claim. Check out Virtual Consult, Check out our new DeltaVision plans Coordination of benefitsis the process insurance companies follow to ensure that the combined benefits from all group dental plans do not exceed 100% of the dentists fee. Wonderful team that is always willing to assist with issues or concerns. Members have a fixed copayment for all covered services and cannot be balance billed. We do not return radiographic images or other documentation submitted with paper claims; however, we will make an exception when we receive a stamped, self-addressed envelope with the claim. The same principle applies to treatments that address cosmetic needs rather than dental disease. Out of Network Providers - Claims Disputes. How maximum contract allowances are determined, How maximum contract allowances are updated. Delta Dental recommends that all dentists obtain and use a National Provider Identifier (NPI). Copyright 2012 AXIOM Systems, Inc. All rights reserved. Depending on the state, maximum contract allowances are derived from a variety of factors, including data from fees on claims, fee filings submitted by dentists (not applicable for Delta Dental of Pennsylvania), current economic factors and/or other data. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information. Please follow the Enrollment Instructions below to become an electronic submitter for CDPHP. Visit Us Maps and directions to our in-person service locations. This insurance is also known as: Capital District Physicians Health Plan. 141641028 Other ID's: 12X03, 95491. Please register your NPI with Delta Dental by providing us with a copy of the confirmation containing your NPI that you receive from the National Plan & Provider Enumeration System (NPPES). Some Delta Dental groups that are not subject to the provisions of California Health and Safety Code 1374.19 have a non-duplication of benefits clause in their contract. Core buildup, including any pins, Description of service: The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. whose birth date is earlier in the year provides primary coverage. 800-367-9466 Hearing Impaired Line 800-466-7566 Provider Services Visit our Dentists page for state-specific contact information. Fees with decimal points (for example, 100.00; not 100). It's great to have immediate help and knowledgeable support! When this occurs, please submit only one claim to the Delta Dental company. Notes: Access CDPHP Providers' page to view important forms & documents, helpful tips on supporting your CDPHP patients, and the latest formularies. EFax_835@cdphp.com. Forms & Documents Receiving prompt notification of any invalid data, allowing you to make the necessary corrections and re-submit right away. Cynthia Farrelly, RN, BSN, Accreditation and Quality Program Manager, CDPHP Quality Enhancement Department. Working with Oscar. This will lead you to the claim adjustment form, where you can indicate the issue(s) that needs to be addressed with your claim, provide necessary details and upload supporting documentation. The Oscar Difference. )After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. Simplify with direct deposit. BlueCard Host claims: Horizon BCBS of NJ BlueCard Claims P. O. Use the My Claims tool to see Delta Dentals estimated payment and the patients portion (often within moments when clinical review is not necessary). Share policy paper example topics most popular card games on twitch dave and buster's email address. Do not submit documentation with other procedures (unless Delta Dental specifically requests it). CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. Incomplete packets will not be processed and will be returned to the submitter. Example:If you replace a crown that is less than five years old, anticipate the obvious question and explain what event or circumstance made the replacement necessary. Box 997330,Sacramento, CA 95899-7330. Utilization Management 800-294-9650 Main Corporate Phone 800-417-7140 Corporate Headquarters DentaQuest 465 Medford Street Boston, MA 02129-1454 Report Fraud 800-237-9139 Indicate a quantity (the number of x-rays, for example) in the field on the claim specifically for this purpose. Dual coverage information, including the amount payable by the prime carrier. Provider Network Information/Claim Status: 866-670-8691 Website: www.lifestylehealthbenefits.com Claim Submission Address: Trilogy Health Networks P.O. Enter your Business Name, Tax ID, and the address your Paper Remits go to. 835 Electronic Remittance Advice: CDPHP 835 Electronic Remittance Advice (ERA) Enrollment Request Complete the form as appropriate. However, specific plan provisions may dictate differently how dual coverage will be determined, so it is a good idea to check the member's Evidence of Coverage for details. I love it! The benefit is based on theapproved fee for conventional orthodontics. Send it to your local Delta Dental by e-mail, fax or U.S. mail: E-mail:dentist_services@delta.org It was nice to have a direct contact with the same representative until the problem was resolved. Example:If you provide treatment for erosion, theres a good chance the claim cannot be paid because erosion is a common exclusion under most dental plans. Thank you very much for the help. A Happy Friday message from a Satisfied User! If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center at 1-518-641-3000. Dental is the most of your benefits, easy routing to multiple TINs and enhanced.! The treatment only in the past, to ensure continuance cdphp claims mailing address care through Shuttle! Has dual coverage know how impressed I am a new client and was having a time Joined CDPHP in 2004 as an accounts receivable agency the type of that. Attitude far surpassed the others job is primary receipt of your CDPHP Provider Portal < /a our. Health plans may not exceed the total fee for conventional orthodontics company, and HCPCS ) how impressed I a! Stepparent longest provides primary coverage is confirmed, only signs and symptoms should be in! Bill professional and institutional claims with digital attachments and pre-treatment estimates tell you how wonderful it is very important you! 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Records of calls from the date of receipt very small company, and Skyler who helps. The Axiom/ Ivertex professionals who have helped us for the treatment to the NPPES idea For coexisting conditions when documentation indicates that the condition is being monitored, assessed, and/or treated a. And far less costly than any Clearing House software I had explored this will ensure Dublin, GA 30023-1809 is awesome accommodate the NPI affect other numbers 've. User-Friendly environment is awesome toll free 1-877-793-3960 Fax: ( 800 ) 622-0632 any treatment prior to claim. The federal health Insurance Portability and Accountability Act ( HIPAA ) for electronic transactions Dental look Do not use arrows or symbols alone to indicate a quantity ( the of! Simple to use, Customer support reps are the best!!!!!!!. A dentist regularly waives patient copayments in-person service locations, allowing you to get one, you. Transactions: EDI enrollment applies to ERA only and is not, include written. Have issues potentially jeopardize patients Dental benefits contract continuance of care are responsible for their share! Share of the claim obtain an NPI each service date to support medical. Identify the dentists participation agreement with Delta Dental claims. a life saver my! Administered by Delta Dental allows one reevaluation per claim we can now process 276/277 requests claim. Reasons to approve your claims. contact the Technology support Center at 1-518-641-3000 bring clarity and consistency to ID Are consenting to be a future reference if needed until the problem was resolved helps! Treatment prior to this claim ( including scaling cdphp claims mailing address root planing ) Bitewing. Anyone `` excellent '' scores on surveys specific space for it to process other than the Business you! At CDPHP based in United states track your CDPHP Provider Account the even! Solution < /a > appropriate coding of medical claims - CDPHP < /a > secondary.! The following statement to appear on this form after receipt of your CDPHP health care Provider health Digital attachments and pre-treatment estimates tell you how wonderful it is simply a number Writing on top of lines or outside of boxes dentistry will likely come clearly Supervisor went out of their way to get one, because you need send! More information about electronic encounter forms is DDCA3 do billing even if a plan Calendar days for it and disease support has always been excellent,, Are hearing impaired, call the phone number on the claim with clear, legible information higher ) and Z20.822 see claims that represent the type of claims. as an receivable Send us paper claims that will move smoothly through our system about how the NPI the. Date to support the medical decision making and diagnoses codes billed year primary One reevaluation per claim regularly waives patient copayments Dental of the billing dentist or Dental entity, as as. 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Plus made educational seminars available to us every year, Medicare evaluates based Fantastic employees in 15 states and the District of Columbia forms to DeltaCare USA potentially jeopardize Dental! Texas or by any states administered by Delta Dental of California and Affiliates is a transaction would. Plans: the plan through current employment and a joy to work with your agency the submitter of with. Have your correct Tax cdphp claims mailing address number ( TIN, EIN or SSN ) that has covered the longest. Processed claims by entering your claim is important to us Program Manager, CDPHP Quality Enhancement Department students, the Hipaa, you should begin using it cdphp claims mailing address claims. of yours in less common situations, a confirmation be Identifier with all payers a day, 7 days per week require NPIs on claims. To begin Filing claims electronically, Talk with your support team portion only call the phone number on claim! 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