In just a few months, a new fee schedule involving contractual amendments and reimbursement changes to Delta Dental of California’s Participating Dentist Agreement will go into effect. This removes previous opportunities that offices had to review their Premier fee schedules and to request a review and possible increases, as Delta Dental now sets these fees without consideration for individual practices.

Our experts are ready to help create a game plan to help you prepare for the changes, which go into effect on Jan. 1, 2023. As some codes may increase in fee, others are decreasing. Have you reviewed these codes and the fee changes? If not, it is a good time to do so. It’s important to know what codes you use the most in your office and how these Delta fee changes may potentially negatively impact your financial state due to some decreased fees on codes you regularly use. Although some codes might increase in fee, if they are not codes you regularly use, it does not make a substantial positive impact.

Details on changes

The significant contractual amendments and reimbursement changes will result in the elimination of the requirement for filing Premier fees. Standard Premier fee schedules will replace the former method. Delta Dental will no longer require Premier dentists to file fees annually.

In addition, there will be some increases to PPO reimbursement schedules and some fee reductions in specialized areas, such as oral surgery and endodontics, but not in all cases. Some Premier-only providers will see no change or will receive a small increase. An aggregate fee increase for PPO general dentists is also expected.

Why are changes being made?

Delta Dental sought the updates to help reduce administrative burdens felt by providers and Delta Dental.

In particular, the elimination of the Premier fee filing process, the simplification of PPO fee schedules and the alignment of specialized care providers’ contractor fees with what is generally carried out in the broader market are the major drivers of Delta Dental’s decision-making.

What will the real-world effect be on dental offices?

Although the administrative burdens of filing Premier fees annually may be lifted, there could be a potential loss of revenue that far outweighs the annual administrative burden.

The economic impact of the new standard Premier fee schedules is not as clear. Delta Dental, however, holds the position that Premier compensation for general dentists will not experience any aggregate market impacts. Specialists will see a reduction.

Most PPO general dentists, who represent a large share of Delta Dental’s network, however, will see an aggregate increase because of the new fee schedule. Others will see none at all.

We’re here to help

Dental offices can reach out to Adams Dental Consulting for support and resources on how to evaluate and implement the pending changes to their contractual processes and obligations.

Announced in September by Delta Dental, dentists in network should have recently received formal notice of the contractual amendments and reimbursement changes. Dental office managers are urged to read the new policies about Premier fees thoroughly and early to successfully navigate the changes.

Delta Dental will offer Premier providers with individualized examples and guidance on how the changes will impact their practice based on their claim submission history.

Whether it’s helping you identify top codes and production impacts, deciding on network participation, or verbiage to communicate changes with patients, ADC is here to help you navigate this situation.

Contact us today with any questions.


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