Medicare Advantage Network Credentialing & Compliance

Delta Dental’s Medicare Advantage membership is growing, and your participation in this network is a great opportunity to increase the number of patients at your dental office. If your dental office is considering joining our Medicare Advantage network or is already participating in this network, you'll need to ensure compliance with the Centers for Medicaid and Medicare Services (CMS) requirements for Medicare Advantage providers. Use this page to connect with the resources you'll need to stay credentialed and compliant.

What Are You Looking For?

Fraud, Waste & Abuse Webinar for Network Providers Fraud, Waste & Abuse Webinar for Network Providers Fraud, Waste & Abuse Webinar for Network Providers
Fraud, Waste & Abuse (FWA) Training

All of your employees must complete our General Compliance and FWA Training annually and within 90 days of hire. This training also includes a cultural competency component to help dental office staff understand and accommodate diverse patient needs.

View Training

Exclusion Screening

Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE)

OIG's LEIE provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other federal health care programs. You should check the list monthly to ensure that new hires and current employees are not on it.

General Services Administration (GSA) or System for Award Management (SAM) List

The GSA similarly maintains several exclusion lists, managed through the System for Award Management (SAM). You should routinely check SAM to ensure that excluded individuals and/or entities are not involved in provision of care or services on behalf of your office.

CMS Preclusion List

CMS maintains a list of providers and prescribers who are precluded from receiving payment for Medicare Advantage items and services, or Part D drugs furnished or prescribed to Medicare beneficiaries. You will receive an email and letter from CMS/Medicare Administrative Contractors in advance of your inclusion on the preclusion list. The email and letter will be sent to your Provider Enrollment Chain and Ownership System (PECOS) address or National Plan and Provider Enumeration System (NPPES) mailing. The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal. Medicare Advantage plans are required to deny payment for a health care item or service furnished by an individual or entity on the preclusion list. To learn more about the CMS Preclusion List, visit CMS.gov.

Additional Resources

Icon_Blue_PDF.png
Icon_Blue_PDF.png

Frequently Asked Questions

If you would like to join our Medicare Advantage network, please email your request to medicarecredentialing@deltadentalaz.com. A member of our Medicare Advantage credentialing team will reach out with next steps.

No problem! If you would like to join the Medicare Advantage network, please email your request to medicarecredentialing@deltadentalaz.com. A member of our Medicare Advantage credentialing team will reach out with next steps.

You can terminate your participation in the Delta Dental Medicare Advantage network without terminating your participation in the other Delta Dental networks by giving 60 days prior written notice. To give notice, please complete the Medicare Advantage Opt-out Notification Form and submit it to us per the instruction on the form.

As a participating Medicare Advantage provider, you will be required to treat patients with coverage through any Delta Dental Medicare Advantage plan, including those administered by other Delta Dental member companies. 

In order to stay current with your Medicare Advantage credentialing, the compliance attestation form must be completed once a year. We will notify you annually when you are due to submit your attestation. 

First Tier, Downstream, and Related Entities (FDRs) are defined by CMS as any party that enters into a written arrangement with a Medicare Advantage Organization or Part D plan sponsor to provide administrative services or healthcare-related services. If your practice is participating in the Delta Dental Medicare Advantage network, you are contracted to provide health care service functions that relate to Delta Dental Medicare Advantage plans and considered an FDR. This also means that your vendors may be considered FDRs and you may be responsible for monitoring and auditing their compliance with CMS standards.

The term “offshore” refers to any country that is not one of the 50 states or U.S. territories. CMS also clarifies that offshore subcontractors includes those who provide services performed by workers located in offshore countries, regardless of whether the workers are employees of American or foreign companies. For example, if your office uses a third-party vendor for patient eligibility and benefits verification and any employees of that vendor are located outside of the United States, the vendor would be considered an offshore contractor.

Yes! We created a mandatory fraud, waste, abuse, compliance and cultural competency training for you and your staff. The training must be completed annually and is available at www.brainshark.com/deltadentalaz/fwatraining.

You will need to check the Office of Inspector General’s (OIG) List of Excluded Individual and Entities (LEIE) and the General Service Administration’s (GSA) System for Award Management (SAM) database on a monthly basis to make sure dental providers and staff in your office do not appear on any government preclusion/exclusion lists that would prevent your practice from participating in the Medicare Advantage network.

Regarding the CMS Preclusion list, you will receive an email and letter from CMS/Medicare Administrative Contractors in advance of your inclusion on the preclusion list. The email and letter will be sent to your Provider Enrollment Chain and Ownership System (PECOS) address or National Plan and Provider Enumeration System (NPPES) mailing. The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal. For more information, visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Preclusion-List

We understand it can be overwhelming to create and administer a compliance program, so we’re here to help! The American Dental Association has a sample compliance plan available at www.ada.org/~/media/ADA/Public%20Programs/Files/The_Compliance_Plan.pdf.

Yes. Per the Medicare Advantage Network Addendum, participating dental offices must keep records for a period of at least 10 years from the last date of treatment.

Notify Delta Dental of Arizona immediately of any change in circumstance. Please contact our Medicare Advantage credentialing team at 866.746.1834 or email medicarecredentialing@deltadentalaz.com.

We’ve updated our dentist manual to include information about Medicare Advantage. You can download a current copy of the Delta Dental of Arizona Dentist Manual in the Dentist Connection.

We are currently reevaluating the necessity of this requirement with legal counsel and Delta Dental Plans Association. If the form is deemed necessary for the Medicare Advantage program, we will create and post a Medicare Advantage non-covered services form on our website at a later date.

Although many Delta Dental member companies administer Medicare Advantage plans, this is a new product for Delta Dental of Arizona. Building a robust network is the first step in partnering with a local MAO, and we are working hard to identify and solidify local MAO partnerships. In the meantime, participating Medicare Advantage providers may treat patients in Arizona with a Delta Dental Medicare Advantage plan administered by another Delta Dental member company.

We are in the beginning phases of creating our network and exploring exciting opportunities to partner with a local Medicare Advantage Organization (MAO). Once we partner with a MAO, we will be able to share additional information on local enrollment statistics. Nationally, Delta Dental member companies provide coverage to more than 1.2 million Medicare Advantage enrollees.

Medicare Advantage plan specifics will be available once we partner with a local Medicare Advantage Organization. Generally speaking, many Medicare Advantage plans have high annual benefit maximums and comprehensive coverage for diagnostic, restorative, endodontics, periodontics, extractions, prosthodontics, oral surgery and other services.

Whenever there is an opportunity to join a new network, there are always questions. We encourage you to learn more about our Medicare Advantage network by watching our on-demand webinar at www.brainshark.com/deltadentalaz/manetwork

We're local!

Claims Address

Delta Dental of Arizona
Attn: Claims Department
P.O. Box 43026
Phoenix, AZ 85080-3026

Mailing Address

Delta Dental of Arizona
P.O. Box 43000
Phoenix, AZ 85080-3000

Questions?

Professional Relations Hours

Monday - Friday
7:30 A.M. - 4:30 P.M.

Call Us