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A network for

Medicare Advantage

Our Medicare Advantage network will help you attract more patients from the fast-growing number of people opting for Medicare Advantage plans in South Dakota.

Medicare Advantage network

We believe everyone deserves a healthy smile. Traditional Medicare doesn't cover most dental care, even though it's an important part of oral and overall health.  Our provider network for Medicare Advantage plans gives more than 200,000 South Dakotans over the age of 65 another option to support their oral and overall health.

Network highlights 

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    Participating providers are reimbursed at their current Delta Dental commercial fee level.

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    Providers already participating in our commercial network are automatically included unless they opt-out.

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    Participating will help you attract and retain patients with dental benefits from the growing number of South Dakotans over age 65.

Plan partners

We're pleased to partner with leading health insurers to provide dental benefits for their Medicare Advantage plans.

See what plans are now available in South Dakota.

Patients & claims 

Patient information

Benefits, eligibility, and claim information are available online. NOTE: use your current DDSD username and password if already registered.

Customer service

For claims questions and other customer service inquires (M-F 7:00 a.m. - 7:00 p.m. CT) call:

Electronic claims

Payer ID number: SDCMS

Mail claims

Delta Dental of South Dakota, PO Box 9215, Farmington Hills, MI 48333-9215

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Frequently asked questions

Medicare Advantage plans 

A Medicare Advantage plan (sometimes called Part C) is a type of Medicare health plan offered by a private company approved by the federal Medicare health insurance program. Medicare Advantage plans provide all of the traditional Medicare benefits and often include benefits not traditionally covered by Medicare, like dental, vision and hearing.

Medicare doesn't cover most dental care, nor do Medigap plans, even though it's an important part of oral and overall health.

Offering dental benefits in select Medicare Advantage plans gives older South Dakotans another option and opportunity to support their oral health.

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and others.

Those with Medicare coverage have the option to keep traditional Medicare or transition their coverage to a Medicare Advantage plan. This happens at the 65th birthday or during open enrollment each fall. 

As people with employer-based dental plans retire, many look to Medicare Advantage plans for similar dental benefits and network access to continue dental care with their existing provider. 

As of June 2023, more than 64,500 Medicare beneficiaries in South Dakota were enrolled in Medicare Advantage plans. That's more than 33% of the state’s Medicare population. This is a significant increase from recent years and steady growth in Medicare Advantage plans is expected to continue in the coming years.

Yes. All Medicare Advantage plans have the same benefit period. Medicare Advantage organizations must submit their plans to CMS in June. Open enrollment takes place between October – December. All plans are effective January 1. Any benefit changes to plans would also be effective January 1.  

Network participation 

 

In 2021, the Centers for Medicare and Medicaid Services (CMS) clarified that rules prohibiting payment to providers who have opted out of participation in Medicare don’t apply to supplemental benefits, like dental, provided through Medicare Advantage plans. The policy became effective January 1, 2022.

That means that if you’ve opted out of Medicare through CMS, you can still join the Delta Dental Medicare Advantage network, provide services to Medicare Advantage members who have Delta Dental of South Dakota dental benefits in their plan, and receive reimbursement for covered services.

 

Participating providers will be reimbursed at their current Delta Dental commercial fee level for Medicare Advantage enrollees.

That's easy! As a current participating member of the Delta Dental of South Dakota provider network, you will be automatically enrolled in the new Medicare Advantage Network.

The Delta Dental of South Dakota Participating Dentist Rules will include a Medicare Advantage Regulatory Amendment unless you choose to opt-out of the Medicare Advantage Network.

Provider requirements are included in the Medicare Advantage Regulatory Amendment, adopted by the DDSD Board of Directors at its May 14, 2021 meeting.
 
The amendment becomes part of the Delta Dental of South Dakota Participating Dentist Rules unless you opt out of the Medicare Advantage network.
 
Please review the amendment for the details of the provider requirements. We think you'll find that most of the requirements are things you're already doing, like getting written consent for non-covered services prior to treatment.

Yes, you have the option to opt-out of the Delta Dental Medicare Advantage Network. Opting out will not affect your current participation in our Premier or PPO Plus Premier commercial network.

Visit the Network opt-out section of this page for more information on opting out of the Medicare Advantage network. 

No. A dentist cannot participate in the Medicare Advantage network only. Participation in our Premier or PPO Plus Premier network is required to participate in the Medicare Advantage network. 

Yes, and we're glad you want to participate! Joining the network is easy - just contact the Professional Relations team at Delta Dental of South Dakota at 877-841-1478 or professionalrelations@deltadentalsd.com

Medicare patients & claims 

Patients with a Medicare Advantage plan with dental benefits from Delta Dental of South Dakota - or someone considering such a plan - will be able to search dentists in the Delta Dental Medicare Advantage Network using the Medicare Advantage "Find a dentist" tool on our website.

Medicare Advantage plan member cards will have unique identifiers that show they have dental benefits. See a quick guide or find detailed information for each plan on our Medicare Advantage plan partners webpage.

Delta Dental of Michigan (DDMI) administers Medicare Advantage claims on behalf of Delta Dental of South Dakota. Information on submitting claims electronically or by mail is available on the Medicare Advantage network webpage.

  1. The Medicare Advantage Plan will pay primary over any Medicaid, retiree, or individual plan.
  2. The Medicare Advantage Plan will pay secondary to any employer sponsored, automobile, or group plan you may have, except those listed in (1) above.
  3. If the Medicare Advantage Plan is the Primary Plan, it will pay its benefits according to its terms of coverage and without regard to the benefits under any other Plan.

If the patient has other coverage through Delta Dental of South Dakota, mark clearly on the claim that there is coverage through Medicare Advantage and attach the Primary EOB when applicable.

CMS requires the patient complete a non-covered services form prior to treatment to ensure the patient understands what their financial responsibility will be for services received. Having the signed form in hand protects the dentist and dental office if the patient questions their out of pocket cost post-treatment. 

Like other dental insurance, each Medicare Advantage plan has its own billing instructions. Providers should look at the ID card or contact the number on the card for information about submitting claims for out-of-state patients with another Medicare Advantage plan.  

Just as with commercial insurance, if the provider is in network the payment will go directly to the provider. If the provider if out-of-network, the payment will go directly to the patient unless the patient assigns the benefits to your office. 

The payer ID for submission of electronic claims is SDCMS.

Network opt-out 

Yes, you have the option to opt-out of the Delta Dental Medicare Advantage Network. Opting out will not affect your current participation in our Premier or PPO Plus Premier commercial network.

All dentists operating under the same TIN must agree to either participate in the Medicare Advantage network or not, which means all dentists in the practice need to participate or all dentists in the practice must submit an opt-out form. 

To opt-out, complete the online opt-out form and sign the confirmation document that will be emailed to you after submitting the online opt-out form.

Network opt-out

Dentists who want to opt-out of the Medicare Advantage network must complete on online form and electronically sign a confirmation document that indicates the provider has elected to opt-out.

Online opt-out form

Compliance information 

As a Medicare Advantage provider, we are your partner to ensure best practices to prevent and detect fraud, waste, and abuse.

Visit this webpage for more information about our compliance responsibilities, a special training presentation deck, and how to report suspected fraud, waste, and abuse. 

Questions?

Contact our Professional Relations team with any questions you have about the new Medicare Advantage network. We're happy to help!

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Wellmark® is a registered trademark of Wellmark, Inc. Wellmark Blue Cross Blue Shield and Wellmark Advantage Health Plan, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Delta Dental is an independent company providing dental administrative services on behalf of Wellmark Advantage Health Plan.