Our newest network will help you attract more patients from the fast-growing number of people opting for Medicare Advantage plans in South Dakota.
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
Participating providers are reimbursed at their current Delta Dental commercial fee level.
Providers already participating in our commercial network are automatically included unless they opt-out.
Participating will help you attract and retain patients with dental benefits from the growing number of South Dakotans over age 65.
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.
Benefits, eligibility, and claim information are available online. NOTE: use your current DDSD username and password if already registered.
For claims questions and other customer service inquires (M-F 7:00 a.m. - 7:00 p.m. CT) call:
Payer ID number: SDCMS
Delta Dental of South Dakota, PO Box 9214, Farmington Hills, MI 48333
When performing services that are not covered, providers are required to have written documentation with the member that indicates the member agreed to pay for the non-covered services. This sample form or a similar form can be used and kept on file.
Medicare Advantage plans
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.
Just 10% of the 200,000 South Dakotans over the age of 65 currently participate in a Medicare Advantage plan.
Steady growth in Medicare Advantage plans is expected 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
The Centers for Medicare and Medicaid Services (CMS) recently 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.
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 "Find a dentist" tool on our website.
Medicare Advantage plan member cards will have unique identifiers that show they have dental benefits. See 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.
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.
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.
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.
Contact our Professional Relations team with any questions you have about the new Medicare Advantage network. We're happy to help!
Phone
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.
Copyright © 2023 Delta Dental of South Dakota. All Rights Reserved.
720 North Euclid Avenue, Pierre, SD 57501 | 605-224-7345
Delta Dental of South Dakota is a part of the Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
The information provided on this site is for general education purposes only and is not intended as a diagnosis, treatment, or a substitute for professional medical or dental advice, diagnosis, or treatment. Consult your dentist or physician for information or treatment specific to you and your health.
አማርኛ Français Srpsko-hrvatski 中文 Deutsche नेपाली 한국어 Adamawa Oromiffaa Русский Español Tagalog Українська Tiếng Việt 