Delta Dental Update: Fee Setting Methodology Change

Delta Dental of California in March notified all its member orthodontists that important changes were being made for Delta's fee filing methodology and Participating Dentists Rules and Agreements.

These changes took effect on May 20, 2004.

The present system "Composite Customary Fee System" was often frustrating and time-consuming because of the complexities of the "weights" of each fee that Delta used in its calculations.

The composite system often took the appearance of "lucky-guessing" of what Delta would accept as fee.

Delta's stated goal is to make the new fee system simpler and more logical in linking reimbursements to current fees charged. With this new system, your current accepted fees and Delta's payments will not change. Delta will grandfather your current accepted fees into the new system.

However, when you file your next fee revision, the way that Delta will evaluate your fees will be different. When you file your fees, Delta will calculate your "Maximum Plan Allowances" and send them to you.

The good news is that your current accepted fees are grandfathered so if some of your accepted fees now are higher than the new maximum plan allowances you will still receive your higher grandfathered accepted fee.

Delta says that it will not lower your grandfathered fees even if you file new fees that are higher than its 80th percentile allowances.

Delta's new fee determinations will still be based on 27 "fee regions" which overlay markets with the 32 dental society boundaries. The 80th percentile allowances for Orthodontists will still be based only on the fees of the state's orthodontists.

Delta will still update these allowances every six month, and member dentists can still submit their fee revisions every 12 months.

The new system will definitely have a learning curve with a lot of questions. Delta will continuously update their website with new questions and answers. Visit the web site at www.deltadentalca.org/dentist/index.html.

Next: A more recent Delta Dental Update that reports on experience with this change