If You Are a Specialist, Here is What New Jersey DeltaCare Participation Means

Schedule of Maximum Allowable Charges
As a plan dental specialist, you agree to provide specialty care dental services which have been approved for referral by DeltaCare, and accept the schedule of maximum allowable charges for specialty services as payment in full. DeltaCare will issue a claim payment for covered specialty services, less any required patient copayment.

Patient Copayments
Certain services require the member to pay a copayment directly to the dentist. The dentist must look directly to the patient for the copayment and may collect it at the time the service is rendered or may make alternate billing arrangements. The dentist should furnish a statement to the member showing the services rendered and the amount of copayment required under the DeltaCare plan. Patient copayment amounts are scheduled according to the plan design selected by the employer group.

Plan Designs
The standard plan designs (Plans E, F, G, and H) indicate patient copayments for each plan are included in the participation kit. Should DeltaCare modify or add new plan designs, a copy will be mailed to you.

Non-Covered Services
For non-covered services, the dentist may charge his or her usual fee and look directly to the member for payment. In such cases, the dentist agrees to advise the member of service professionally recommended but excluded from coverage, give the member the option to proceed with such services at the member's expense, and look to the member for the total fees for excluded procedures.

DeltaCare is underwritten and administered by Flagship Dental Plans, a wholly-owned subsidiary of Delta Dental of New Jersey, Inc.