Click on a link below to see the "Delta Dental Difference."
Delta Dental of Wyoming is the leader in implementing aggressive cost management programs. Our programs have a positive impact on how dental care is administered and delivered. The Delta system's cost management capabilities save groups and subscribers over $4.4 billion annually on a national basis. Active cost management measures include:
1. Designing benefits to anticipate problems. We stress preventative care and coverage for cleanings, examinations and x-rays to try and prevent problems in the future.
2. Coordination of Benefits (COB). We communicate with other dental carriers to determine primary and secondary payment liability. The Birthday Rule is used in determining the first payor for dependents. Our COB procedures are flexible and efficient to prohibit double payments on the same claim. With our large data-base, our capabilities to coordinate efficiently with minimal employee involvement has proven to be of great value in cost management.
3. Dental Consultants. Approximately 15% of our claims are reviewed by professional consultants. Our dental consultants review claims showing either unusual services or excessive utilization patterns to assure proper payment.
4. Utilization Reviews. Delta's utilization reviews examine pre-and post-treatment activities and track ongoing practice patterns. We can identify potential over-utilization and determine the appropriateness of treatments.
5. "Performance Improvement Program". Delta carefully monitors in-house performance to assure payments are correct and claims processing is efficient.
6. Market Development and Research. Our national research on maintaining quality of dental care while controlling costs has been published in leading national journals and magazines.
Delta Dental is a nationwide non-profit organization of healthcare service plans, which underwrites and administers employee dental benefit programs. Delta Dental is unique in that we contract with more than 118,000 dental providers nationwide to service subscribers with dental care at previously agreed upon fee levels.
Delta Dental of Wyoming can offer groups a uniquely different approach for
dental coverage for their employees and dependents throughout the
The Delta Dental System is the leading administrator of dental benefits
programs in the
Delta Dental of Wyoming provides coverage to over 850 groups in
Delta Dental's success is the direct result of the
special features of our programs including:
Nationwide participating dentist network (over 118,000)
Demonstrated cost and quality controls
Commitment to service and administrative excellence
Paperless claim system
Significant system flexibility
Ability to establish local and national networks
Funding flexibility
In-house utilization review
DELTA DENTAL'S CLAIMS PROCESSING SYSTEM
Delta Dental's claim system fully integrates processing, membership information, financial reporting and utilization review. Its single database design ensures processing accuracy through all systems' functions.
Integrated membership files may allow immediate updates from our clients' personnel files directly into the eligibility records used for claims adjudication.
Benefit design flexibility lets Delta Dental fully automate our clients' benefit requirements including deductibles, yearly and lifetime maximums, co-payment factors, and covered and non-covered expenses.
Computer-driven data reporting makes it easy to procure utilization,
financial and other statistical information.
Our large database results in vigorous data control and produces data
accuracy and precise utilization analyses of all coverage.
Delta Dental offers a complete analysis of benefit trends and employee
use patterns for comprehensive reports. Our reports are easy to
understand and usable.
DELTA DENTAL'S COST CONTAINMENT FEATURES
Cost Containment is an important feature of Delta Dental. We offer Cost Containment in several categories.
We have Pricing Cost Containment which is a feature that most other carriers do not have. This feature encompasses the dollars saved from claims submitted that exceed the dentist's filed fees. When an employee uses a participating dentist, these amounts are not chargeable back to the patient. When using a non-participating dentist, fees are based on a lesser percentile and therefore represent a savings to the group.
We also offer reports concerning Eligibility Costs Contained, Contracts/History Costs Contained, and Professional Review Costs Contained. While we feel that Delta Dental provides the most efficient cost containment in all three of these areas, we also provide superior savings from the Professional Review Feature, that is the review of certain claims by our "in house" Dental Director.
Another type of cost containment is Coordination of Benefits. Delta Dental is proud of the magnitude of costs that are contained because these savings keep the costs down for the patient and inevitably for the group. These Containment features manifest themselves as smaller increases in premiums at renewal.
Delta Dental feels that pricing and professional review are the two areas of containment savings that are far superior to those of any other carrier. Because "Dental" is all that we do, our expertise in this area is beneficial to you.
A recent 2005 survey of Delta plans by Delta Dental Plan Association indicates that Delta Dental of Wyoming saved its groups 21.57% (total savings over submitted charges) utilizing eligibility verification, dental consultant review, coordination of benefits, non-covered services, non-billable services, and filed fees.
DELTA DENTAL'S UNIQUE REIMBURSEMENT
The cornerstone of Delta Dental's cost management program is the unique agreement Delta Dental has with each participating dentist. The participating providers submit their fees to Delta Dental. Delta Dental establishes confidential and proprietary plan maximum allowable fees for each service from the submitted filed fees. Payment to participating dentists is the lowest of the submitted, pre-filed, or plan maximum allowable fee. If the plan maximum allowable fee is less, the participating provider accepts payment and agrees not to charge the difference to the subscriber. The "Hold Harmless" agreement protects employees from unanticipated charges and saves claims dollars, that is, the patient may not be charged for excess charges above usual and customary if the procedure is a benefit of the plan.
ADVANTAGES TO DELTA DENTAL'S PRICING
* Delta Dental always pays the lowest fee among the submitted, pre-filed, and plan maximum allowable fee.
* The participating providers submit claims to Delta Dental and payment is sent directly to the provider in a timely fashion.
* Employees do not have to complete or submit claim forms when receiving services from participating providers.
* Dental experts review claims to determine if treatment is appropriate.
* Delta Dental verifies cost savings via production of a cost containment management report.
DELTA DENTAL'S
PAYMENT PROCEDURES
Participating Dentists: Delta Dental of Wyoming has a participating
network that includes approximately 85% of
A. Employees may select from more than 118,000 participating providers nationwide.
B. The provider submits claims directly to the Delta Dental of Wyoming
Service Center in
C. Payment is the lowest of:
* Dentist's filed fees with the local Delta plan
* Dentist's charges
* 90th percentile of local Delta Maximum Plan Allowance.
D. "Hold Harmless Agreements" are based on the local Delta Dental's agreements with providers.
E. Delta Dental pays dentists directly.
Non-Participating Dentists
A. Employees may select any non-participating dentist and still receive benefits.
B. The employee pays the dental provider. The employee or
non-participating provider submits claims directly to the Delta Dental of
Wyoming Service Center in
C. Payment is the lowest of::
· Dentist’s charges
· Delta Dental Plans Maximum Allowable Amount
D. Delta Dental of Wyoming pays the employee.
E. Employees can be billed for additional out-of-pocket expense above the table of allowance.