Claim Forms Must State Actual Amount Collected for Services

Dentists must correctly report to Delta Dental of New Jersey only the actual dollars being collected for the services reported on their claims. 

Delta Dental occasionally finds that a patient will barter with a dentist for dental services. Delta Dental does not object to bartering per se. However, only the actual dollars collected by the dentist may be submitted on claims. Dentists may not submit claims that include an estimated value of property or services received in lieu of monetary payment. Claims that include anything other than actual dollars intended to be collected from patients inaccurately reflect the dentist’s fee. 

Submitting claims that include the value of a barter exchange is one of the unacceptable billing practices reviewed during the claim verification process. It can result in overpayments that are recoverable. If a claim form is intentionally submitted with inaccurate fees, it may be considered a fraudulent attempt to gain benefits. 

For more information, please refer to:
The Delta Dental of New Jersey Dentist Handbook for Participating Dentists, Chapter 11, Claim Verifications.