straighttalk MO – March 2021 (Print)

You can reduce your hold time when contacting our customer service team. Delta Dental of Missouri has two self-service options for providers that seek benefit information and eligibility for their patients. The customer service interactive voice response (IVR) system will send benefits and eligibility information to your office. And our provider portal will also provide eligibility, patient history, and benefit information. Simply login or create an account by visiting our website at www.DeltaDentalMO.com.

We want to provide you with the newest updates and information about EFT/ERA to help streamline office processes. Delta Dental of Missouri does not have access to your secure RedCard account information. For password reset assistance, providers should contact Smart Data Solutions at (855) 297-4436.

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.

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.

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 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 RedCard for any updates or changes.

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

In the fall 2017 edition of The Beacon, the American Association of Dental Consultant’s quarterly newsletter, an endodontist, William Pack, D.D.S., M.S.D., wrote an article titled “An Endodontist’s Admonition for Submitting Code D3331.” The codes D3331 (treatment of root canal obstruction) and D2955 (post removal) are commonly denied for being part of the primary procedure, especially endodontic retreatment claims.

Dr. Pack supported his opinion on the approval of submitted code D3331 by writing that when canal obstructions are confronted, operating costs increase. He stated that these cases often require “several extra packs of hand files” and can require “specialized instruments” such as ultrasonic handpieces and file retrieval systems. Admittedly, a modern well-equipped office providing endodontic treatment will have many adjunctive types of equipment adding to the basic expenses and overhead of practicing. Using extra hand files for such cases does not merit the submission of accompanying high fees, commonly hundreds of dollars.

Another article of significance was written by an endodontist, Ali Behnia, D.M.D., M.S., in the June 24, 2016, American Association of Endodontists’ (AAE) monthly newsletter, The Communique. The article was posted in the Advocacy Practice Management section and titled “CDT Codes D3331 and D2955: Use, Don’t Abuse.”

Dr. Behnia, who was the chairperson of the AAE’s Practice Affairs Committee, discussed a meeting which he attended with several prominent AAE officers and 20 dental directors representing large dental insurers. The main theme taken away from the meeting was that the insurers consider these two codes to be overused and abused. He stated that one dental director referred to D3331, only partly in jest, as a “revenue enhancement code.”

Both Dr. Pack and Dr. Behnia agreed on one important conclusion: providers must use all available modalities to thoroughly document their treatments. These can include clear, properly angled radiographic images, CBCT images and well-illuminated, possibly magnified intra-oral photographs. Along with the images, detailed narrative and chart notes should be submitted explaining and describing all specialized instruments used. These types of requirements also apply to post removal. This procedure can vary between using an ultra-sonic handpiece on a prefabricated post which pops out of the canal after a few seconds of vibration to drilling through a solid cast gold core. These procedures are often tedious, so, if extra appointment times are needed, that is significant.

In closing, with adequate documentation, consultants can fairly adjudicate and decide whether to approve these codes of treatment.

There are a number of categories of procedures that require a radiographic image to allow for appropriate claim review. The following are the most common procedures that when radiographs are submitted the claim processing and turnaround are improved.

Scaling and root planing (D4341, D4342): Bone loss is the primary requirement for approving a claim for scaling and root planing. Bite-wing radiographs are the best image to display the bone level around teeth. Bite-wing radiographs should be submitted for every claim that includes scaling and root planing. Without bite-wing radiographs the claim for scaling and root planing cannot be reviewed.

Crowns and Build ups (all crown codes: D2720 – D2794; and D2950): Crowns are a benefit when the amount of tooth structure lost cannot be repaired by any other means. Build ups are a benefit when the amount of tooth structure remaining is not sufficient to provide retention for a crown. A periapical radiograph provides the most information regarding the loss of tooth structure and the health of the remaining tooth. Photographic images also provide significant information regarding the amount of tooth structure that has been lost. Submission of either or both of these images will greatly improve claims processing and turnaround time.

Extractions (D7140 – D7250): Extraction codes are categorized for the most part by the position of the tooth and the surrounding tissue and/or bone. The surrounding bone is the most important element in determining the most appropriate extraction code to use. A radiographic image (periapical radiograph or panoramic radiograph) can provide a clear representation for the position of the tooth with respect to the surrounding bone. Claims submitted with diagnostic quality radiographs are processed much quicker than claims submitted with radiographs.

When additional clinical documentation is needed to make a benefit determination, Delta Dental of Missouri will indicate that on your ERA or EOB. A new claim form is required with the submission of any requested documentation. Attach x-rays, photos and any narratives to a new claim form and submit it to us for benefit determination. Clinical documentation submitted with the EOB is no longer accepted.

Effective 12/1/2020

Effective 1/1/2021

Effective 2/1/2021