Our delivery model
Our dedicated government programs team is committed to investing in areas where we can make a difference. From regulatory requirements to community investments, we understand the markets we serve both personally and professionally, which leads to exceptional outcomes for you and your community. The operational areas below are part of a comprehensive suite of services that Delta Dental offers our current clients.
Encounters
We consistently achieve CMS targets to ensure clients meet reporting requirements and avoid penalties.
Customer Service
Our team is trained specifically on program requirements to best meet member needs.
Compliance
Experts in federal and state requirements that continuously exceed audit and compliance expectations.
Operational Support
Dedicated government programs team to support all operational needs, from implementation to day-to-day program performance.
Quality Improvement
If you’re seeking better oral health outcomes for your organization’s health program, Delta Dental can help.
Utilization Management
Comprehensive utilization management program that ensures quality care with appropriate dental service delivery and robust prevention of fraud, waste and abuse.
Network Management
Customized networks to meet client and state adequacy needs while delivering improved member health.
Clinical Innovation
Clinical experts and data analysts provide your organization with a range of integrated services, including unique strategies to engage providers and increase member benefit utilization.
Encounters
Delta Dental consistently exceeds Centers for Medicaid and Medicare Services (CMS) targets, with 99.6 percent encounter acceptance rates (CMS target of 98 percent) across all programs. Through timely submissions and low error rates, our encounter team helps you to develop payment innovation, and in turn, improves overall member experience.
%
2022 accepted encounter rates
Customer service
We give members and providers a variety of engagement channels to get information and give feedback 24/7 with our mobile app, IVR, website and customer service line. Delta Dental offers people with different abilities, including language barriers, ways to access information.
A 2021 survey of commercial members served by Delta Dental of Michigan, Ohio, and Indiana found that more than 96 percent are satisfied with Delta Dental. With a 99 percent retention rate, we build our partnerships on strong foundations of trust, respect and dedication, resulting in a rich history that is hard to replace.
Our team of legal experts provides leadership and guidance through all audit and compliance requirements for the Centers for Medicaid and Medicare Services (CMS), other federal agencies and state governments.
Monthly compliance review meetings, mock audits and contractual support are provided to clients to facilitate superior program performance and timely reporting for all deliverables.
To date, we’ve had no financial penalties or sanctions as a result of delegated dental function. More than 60 audits, including CMS program, mock, pre-delegation, data validation and annual oversight, have been completed.
Delta Dental is NCQA accredited in credentialing/recredentialing. We are committed to the quality and compliance of providers in our networks, and this accreditation validates our commitment.
Our team specializes in managing government programs and is here to support you from back-end administration to day-to-day support. With an operating model that reflects the unique needs of each market and state, we can provide dental benefits for numerous Medicaid managed care plans (MCPs) that satisfy compliance requirements for each.
- Committed implementation team – From day one, our implementation team will work closely with you to facilitate a step-by-step process of the implementation utilizing a detailed project plan.
- Devoted account manager – Your dedicated account manager will provide day to day support while ensuring all service needs are adequately met for resolution of issues and ongoing requests.
Delta Dental sets industry standards in operations and information management. We provide 24/7 access to information through online toolkits, and offer the most comprehensive, decision-driven reporting for our customers.
- For providers – Dental Office Toolkit
- For members – Member Portal
- For you – Benefit Manager Toolkit
Quality improvement
If you’re seeking better oral health outcomes for your organization’s health program, Delta Dental can help. Our population health management team is ready to work with you to identify and implement person-centered solutions to improve the care and health of your members. We can provide your organization with a range of integrated services designed to assess and improve oral and systemic health across any identified population. Delta Dental believes that addressing oral health needs for members, overcoming social determinants of health (SDOH) barriers to care and incentivizing providers leads to better health outcomes and lower overall costs.
Utilization management
We maintain a comprehensive utilization management (UM) program that provides a spectrum of services to support population health management, ensure quality care and sustain healthy client populations.
Our UM program supports effective utilization of health services.
The misutilization of health services (inappropriate treatment that wasn’t medically necessary or didn’t meet generally accepted standards of care) can adversely affect overall health and well-being. We conduct ongoing data mining and analysis to identify client populations where people’s health care utilization lies outside of the expected norms. This provides us with the group-specific information needed to design corrective interventions targeting individuals, caregivers and providers.
Our UM program supports appropriate delivery of health services.
We audit provider treatment patterns through both automated and human monitoring. Provider claims are electronically evaluated through an extensive set of procedure-specific business rules to ensure that services are appropriate and client resources are safeguarded. When medical necessity must be determined, our experienced professional peer reviewers objectively evaluate provider performance by consistently applying sound clinical principles and evidence-based practice guidelines.
Our UM program supports fair and consistent utilization review.
We routinely monitor the accuracy and consistency with which our professional peer reviewers apply clinical principles and practice guidelines in their decision making. This ongoing evaluation includes peer reviewer credentialing, formal audits of clinical determinations, regular training and periodic peer reviewer testing. In addition, the clinical review criteria used by our peer reviewers are regularly monitored for conformance with prevailing practice guidelines and treatment norms.
Network management
By placing considerable emphasis on provider enrollment and retention, Delta Dental is able to offer some of the nation’s largest networks of dentists.
- We design networks with strategic incentive programs and tiered fee schedules, to increase provider participation in all regions and specialties.
- Ongoing provider education programs, culturally appropriate training, and dialogue tips for engaging unique populations are just some of the outreach efforts we supply to our panel of providers.
- With diligent tracking and trend analysis on provider utilization, we are able to monitor for fraud, waste and abuse.
Delta Dental of Michigan, Ohio, and Indiana is NCQA accredited in credentialing/recredentialing. We are committed to the quality and compliance of providers in our networks, and this accreditation is just another way we prove our responsibility to this
Clinical innovation
Clinical innovation examples that are scalable in any market include:
Clinical performance dashboards
Clinical performance dashboards drive insights on member needs and spending that allow for optimization of dollars spent and value gained.
Targeted text message and education campaigns
Targeted text message and education campaigns that use actual members and providers from the community who understand a member’s needs and speak their language. Text messages may include targeted messages on screenings, risk assessments, benefits and more, and dedicated care coordinators help to connect members with their benefits by reducing SDOH barriers such as transportation, language differences and more.
Value-based payment programs
Value-based payment programs that incentivize providers to deliver necessary services that benefit members’ dental health and overall health, but also benefit the provider by growing their practice and increasing revenues.
Health risk assessments
Health risk assessments that provide detailed information on members’ chronic conditions for enhanced member outreach, increased benefit access and data analysis.