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Individual Plan Brochure

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LifeSmile Oral Wellness

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INTRODUCING: DELTA DENTAL'S NEW HOW® PROGRAM

Delta Dental of Idaho is proud to introduce the NEW Health through Oral Wellness® program, or HOW® for short. HOW is a unique, patient-centered program that adds additional benefits to dental plans, based on the patient's individual oral health needs. By performing a simple risk assessment at the beginning of the patient's visit, high-risk patients may have access to additional preventive and health-sustaining benefits.

Learn More
HOW® Provider Program Overview
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Receive Additional Dental Benefits for High Risk Patients

Delta Dental of Idaho Dental Benefit Plans

— Frequent Questions —

Providers

To what address do I mail my claims?

Claims for all Delta Dental of Idaho subscribers should be mailed to:

Delta Dental of Idaho
P.O. Box 2870
Boise, ID 83701

We encourage electronic submission of claims for faster turnaround time and improved provider cash flow.

When is Customer Service available to answer my questions?

We have several options to get answers to your questions.

  • Online: You can access benefits and eligibility information and claims status online in the Dentist Log-In section of our website. To access this secure portion of our website, you will need to be registered for online use. If you are not currently registered, you can Register Here.
  • ProFax: You can obtain benefits, eligibility, and claims information via your fax by calling (208) 489-3545 or toll-free (866) 452-4154.
  • Call Customer Service: Our Customer Service Representatives are available Monday through Thursday from 7:00am to 5:30pm and from 7:00am to 4:00pm on Friday at (208) 489-3580 or 800-356-7586 to assist you with questions.

What procedures require x-rays?

Delta Dental requires x-rays for the following reasons:

  1. For two or more crowns and for all anterior crowns
  2. Crown buildups
  3. Onlays and veneers
  4. Impacted teeth
  5. As requested by our Dental Consultant to clarify specific cases

What procedures require perio charting?

Delta Dental requires perio charting for the following procedure codes:

  • D4210 Gingivectomy or Gingivoplasty – four or more contiguous teeth or bounded teeth spaces per quadrant.
  • D4211 Gingivectomy or Gingivoplasty – one to three contiguous teeth or bounded teeth spaces per quandrant.
  • D4240 Gingival Flap Procedure, including root planing – four or more contiguous teeth or bounded teeth spaces per quadrant.
  • D4241 Gingival Flap Procedure, including root planing – one to three contiguous teeth or bounded teeth spaces per quadrant.
  • D4260 Osseous Surgery (including flap entry and closure) – four or more contiguous teeth or bounded teeth spaces per quadrant.
  • D4261 Osseous Surgery (including flap entry and closure) – one to three contiguous teeth or bounded teeth spaces per quadrant.
  • D4341 Periodontal Scaling and Root Planing – four or more teeth per quadrant.
  • D4342 Periodontal Scaling and Root Planing – one to three teeth per quadrant.

How are orthodontic claims processed?

Standard processing provides for an initial payment and periodic payments for orthodontic treatment. Once benefits are established for a case, payments are issued automatically.

What is the value added orthodontic discount program?

Delta Dental members with the value added orthodontic discount program experience substantial savings because Idaho orthodontists in the Orthodontic Discount Program agree to discounted fees. The discount is based on the length of treatment.

How does a dentist become a Participating Delta Dental Dentist?

The process to contract with Delta Dental requires a signed agreement and a credentialing process. Please call Delta Dental Provider Services at 800-356-7586.

By which methods can I submit claims?

There are several ways to submit claims to Delta Dental of Idaho.

  • Online: We provide free claims submission online. Simply click on the Claims option after logging in to the secure Dentist section of our website and then click "Submit New Claim."
  • Electronically: We accept electronic claims through Emdeon, Dental Xchange, and Tesia. Our Payer ID # is 82029. We also accept electronic attachments through National Electronic Attachments (NEA), NIS, and Emdeon.
  • Mail: You can mail paper claims to: Delta Dental of Idaho, P.O. Box 2870, Boise, ID 83701.

What is the turnaround time for claims processing?

Currently, Delta Dental processes all claims in less than three (3) business days on average from the date the claim is received. Payments are issued weekly.

What can we collect from the patient at the time of service?

The co-payment, deductibles and charges for any non-covered services.

How are the dental policies determined?

Delta Dental has a Dental Advisory Committee, which includes licensed dentists in private practice. The Committee recommends policy adoption or changes based on generally accepted dental practice and changes to the ADAs Common Dental Terminology (CDT) codes. Some policies may also be developed by the National Delta Dental Plans Association Dental Policy Committee and adopted by Delta Dental of Idaho.

Plans with both PPO and Premier coverage

If the treating dentist is participating with both PPO and Premier plans, and the dental coverage is PPO, payment is based on PPO fees. If the dentist is Premier-only, payment is based on Premier fees. Coverage can vary by plan.

If a claim is denied, how do I request reconsideration?

When claims are processed, you will receive a Claim Payment Statement. This statement explains how the services were processed. If you disagree with the processing outcome of the claim, you may supply Delta Dental with additional information to support the services rendered and we will review the claim with a Dental Consultant, using the additional information, the processing policies and the group purchaser’s contract.

How are my fees determined?

Fees are reviewed annually by Delta Dental and may be changed based on market conditions and claim analysis.

Who decides what the yearly maximum for services will be?

In most instances, the employer group, who is purchasing dental benefits for their employees, is the decision-maker regarding the benefits (co-pays, deductibles and maximums) to be offered to their employees.

Does Delta Dental offer individual plans?

Yes! Visit http://www.deltadentalid.me/ for more information and to enroll.

I have Delta Dental of Idaho Individual and Family Plan brochures in my office, how can I order additional brochures?

To order additional Individual and Family Plan brochures, please call (844) 759-6020 or visit http://reorder.rgcnet.com/.

Dental Office Deals

As a Delta Dental of Idaho network member, you gain access to discounts of up to 45% on office supplies, equipment, and services that you likely use every day! These Dental Office Deals are provided to our dentists at no additional cost. In addition, Dental Office Deals will strive to "lock" prices in their agreements for the duration of contract terms while establishing measurable standards for service quality. Become a part of this community that works together in order to attain the best value possible. Enter the Access Code "DeltaDental" to Enroll today!

Access your Delta Dental discounts by calling 1-800-768-2715 or sending us an email at info@dentalofficedeals.com.

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Cellular Service


Cellular Service

Obtain discounts on monthly cellular phone costs with Sprint and AT&T. Discounts are available to direct dental practitioners and their employees, even if you are using their service now.
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Office Supplies


Office Supplies

Reduce office and break room supply expenses by 40 percent with Office Max, Staples, and Georgia Pacific with Staples Business Advantage. Staples also offers discounts on online printing for larger print jobs. You can also receive competitive pricing on hardware & software, system planning & design, training, technical support, wiring and even web development with PC Connection Inc.
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Dental Supplies


Dental Supplies

Receive exceptional discounts on crowns, bridges, orthodontics, removables, implants, CAD/CAM restorations, emergency medical kits, defibrillators, handpiece repair, sterilization monitoring products, carbides, and more.
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Business Services


Business Services

Increase your incoming rate of new patients with specialized online marketing services from Bullseye Media for a low monthly fee and no contract. Services include assistance with brand protection, online directory optimization, and creative social media content.
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Shipping


Shipping

Save up to 52 percent on overnight shipments and 35 percent on ground shipments with FedEx.
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Education and Consulting


Education and Consulting

100+ free online dental education courses with CE credits provided by Proctor & Gamble and Dental Academy of Continuing Education. Reduce risk and maintain accurate records by having a highly trained Dental Health Care Compliance Officer, review, audit, and identify red flags and ensure proper billing and coding procedures. Membership includes free OSHA & HIPAA staff training.

— Giving Back —
To Idaho's Communities

DDID invested over $2 million in 2019 to provide valuable outreach programs for Idaho students and aging adults.

Grins on the Go was created as a free cavity prevention clinic provided to low-income elementary and middle schools throughout the state. Since the program started, more than 70,000 students have received services in the form of dental sealants, fluoride varnish, and 1-on-1 education.

GrinWell for You program provides free preventive and restorative dental procedures to low-income Idaho adults over age 60 and helps them establish a dental home.

— Community Outreach —
All Grins On Deck

See how Delta Dental of Idaho's Community Outreach Program is making an impact in your community!

GOIN' MOBILE

Delta Dental's helpful mobile app provides your customers with quick access to their claims, coverage, and ID cards. We even have a built-in toothbrush timer to help them keep up with their daily brushing regimen!

Download the Mobile App - Apple and Android

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