Specialty Referrals,
Preauthorization, and Payments
DeltaCare has
recently modified the specialty referral process
in an effort to simplify the administration of
the DeltaCare program. For most endodontic, oral
surgery services, and orthodontic services, eligible
DeltaCare enrollees may be referred directly from
the patient's general dentist to participating
DeltaCare specialists. The patient should present
to your office with the proper diagnostic materials
along with a DeltaCare specialty referral form.
For treatments
such as primary care services which are complicated,
surgical or serial extractions and complicated
treatment plans, a preauthorization must be obtained
either by submitting a mail-in preauthorization
form or through an emergency authorization number
by the patient's primary care general dentist.
Please note:
-
For specialty
payment of treatment rendered: The dentist
rendering care must date and sign the specialty
form and submit it to DeltaCare along with
any diagnostic x-rays required.
-
For preauthorization
of treatment plans: Complete the specialty
form and forward it to DeltaCare with the proper
diagnostic materials.
-
Orthodontic
referrals should have an authorization number
on the form to confirm that the patient's group
contract does include orthodontic benefits.
When the general
dentist performs specialty services, please ensure
that the proper diagnostics are submitted when
requesting payment.
DeltaCare
is underwritten and administered by Flagship
Dental Plans, a wholly-owned subsidiary of Delta
Dental of New Jersey, Inc. |
