straighttalk SC – July 2022 (Print)

To help ensure your claims are processed quickly and correctly with the first submission, use the Delta Dental guide below. Organized by procedure categories and listed by procedure and code, the guide lists recommended documentation and additional information.

To help streamline your office’s payment process, enroll for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). The digital process can reduce costs and save time by streamlining manual processes and speeding up revenue cycles. This improvement in efficiency will help providers get paid more quickly. In addition, sharing additional provider email addresses with Delta Dental of South Carolina (DDSC) will help with our communication channels and ensure information gets to all who need it.

For new EFT/ERA enrollment, go to https://enroll.ach835.com/new. You will be required to fill out some basic provider and contact information. RedCard, the EFT/ERA vendor, will then contact you to continue the registration process. You will receive a phone call as well as an email with a temporary username and password along with the login URL. Once registered, be sure to save the website and your login credentials for future communication with RedCard should you need to contact them for any updates or changes.

Current RedCard EFT/ERA registrants who need to update their account or profile should login to their RedCard account. This will allow providers to update their profile and practice information and add payers. If your practice has multiple NPIs under one TIN and you want all payments for all NPIs to go to the same financial institution account, leave the NPI fields blank.

A few things to note:

• • If after you have updated your information and there is a discrepancy or mismatched information, the payment will drop to paper until that information is corrected and/or verified.
  • Please note updating financial institution information will trigger a new test deposit. This will need to be verified before updated EFT/ERA enrollment information is complete. In the meantime, payments could drop to a paper check.
  • Delta Dental of South Carolina does not have access to your secure RedCard account information. For password reset assistance, providers should contact Smart Data Solutions at (855) 297-4436.

If you have questions or need assistance, please contact RedCard’s Provider Service Center at support@ach835.com or (844) 292-4066.

To share additional provider email addresses with DDSC, please contact our professional relations team at professionalrelationsteam@deltadentalsc.com or reach out to your representative.

Peer-to-peer program

As a courtesy and an opportunity for a professional exchange of information, Delta Dental of South Carolina (DDSC) offers dentists the ability to converse with a dental consultant to understand why a claim was denied. The purpose and objective of a peer-to-peer call is to review a disputed claim or predetermination decision and to obtain any additional pertinent clinical information that may not have been available at the time the initial review was conducted. This is an opportunity for the dentist to provide additional information that may not have been submitted with the claim or may not have been apparent from the image or the narrative.

Information conveyed during a peer-to-peer call for the purpose of enhancing the case for reversal of a claim or predetermination decision does not guarantee that the claim or predetermination decision will be reversed. If any additional information provided during the peer-to-peer conversation gives the dental consultant reason to consider changing the original claim decision, the entire case with the additional information is provided to a different dental consultant for review. If two out of three dental consultants agree that the claim decision should be changed, the original denial will be overturned.

The denial of a claim for services provided can sometimes create an emotional reaction on the part of the dentist whose claim has been denied. We encourage the dentist to understand that denials are based on the criteria set forth in a contract between DDSC and the employer. The criteria or processing policies are the rules that DDSC must follow on behalf of the employer. The purpose of peer-to-peer calls is to provide an avenue for the exchange of information between professionals. At DDSC, we will do our best to serve this purpose.

Peer-to-peer call requests may be submitted through your professional relations representative, customer service representative, electronically or USPS.

Second Re-Eval program for claims

A predetermination or claim is eligible for a Second Re-Eval if your office has received a remittance advice where the submitted code has been replaced with another code or it has been denied by a dental consultant. For example: Per consultant review benefits are not available.

Second Re-Eval requests may be submitted through USPS mail, electronically or through your professional relations representative. The submission of a second re-eval should include any additional information such as x-rays, photos, operative/chart notes, and periodontal charting. The previously submitted clinical documentation along with the claim/predetermination number that was previously denied or recoded should also be submitted with your new claim or predetermination.

Delta Dental of South Carolina is pleased to announce that we will soon launch upgrades in our dental benefits administration system, which will deliver technology enhancements, operational efficiencies and heightened security for our stakeholders, including our participating network dentists and practice staff.

These system enhancements are scheduled to go into effect on Tuesday, August 2, 2022, and will:

• • Increase integration capabilities of our systems and services, as well as business continuity capabilities
  • Ensure the delivery of accurate and highly efficient claims processing
  • Elevate our overall levels of service to you and your practice

A letter with additional details related to our system upgrades was mailed to our participating dentists on Wednesday, July 6. You can also view the letter content on our Provider’s Office page at deltadentalsc.com/Providers.

Thank you in advance for your patience as we launch system enhancements to better serve you.