Processing Policies. The dental care guidelines for the DeltaCare USA plan explain to Contract Dentists what services are covered under this Contract. Contract Dentists will use their professional judgment to determine which services are appropriate for the Enrollee. Services performed by the Contract Dentist that fall under the scope of Benefits of this Contract are provided subject to any Copayments. If a Contract Dentist believes that an Enrollee should seek treatment from a specialist, the Contract Dentist contacts Delta Dental for a determination of whether the proposed treatment is a covered benefit. Delta Dental will also determine whether the proposed treatment requires treatment by a specialist. An Enrollee may contact Delta Dental’s Customer Service Center at 000-000-0000 for information regarding the dental care guidelines for DeltaCare USA.
Processing Policies policies approved by Delta Dental, as may be amended from time to time, to be used in processing claims for payment or review, and processing treatment plans for Prior Authorization or Predetermination. Most frequently used Processing Policies are contained in the terms, conditions, exclusions, and limitations described in this Appendix.
Processing Policies. Policies approved by DDPOK’s Board of Directors, as amended from time to time, to be used in processing treatment plans for predetermination of benefits and for claim adjudication payment. Said processing policies may be provided, upon request without charge, as a separate document, by DDPOK.
Processing Policies. Policies approved by Delta’s Board of Directors, as amended from time to time, to be used in processing treatment plans for Predetermination of Benefits and for payment.
Processing Policies. Delta Dental’s policies and guidelines used for Pre- Treatment Estimate and payment of Claims. The Processing Policies may be amended from time to time. A period outside of the Open Enrollment Period in which you or your Dependent can obtain coverage under This Plan due to a qualifying life event. The amount a Dentist bills to Delta Dental for a specific treatment or service. A Participating Dentist cannot charge you or your Dependents for the difference between this amount and the Maximum Approved Fee.
Processing Policies. Delta Dental’s policies and guidelines used for Pre-Treatment Estimate and payment of claims. The Processing Policies may be amended from time to time.
Processing Policies. Delta Dental’s policies and guidelines used for Pre- Treatment Estimate and payment of Claims. The Processing Policies may be amended from time to time. A period outside of the Open Enrollment Period in which you or your Dependent can obtain coverage under This Plan due to a qualifying life event. The amount a Dentist bills to Delta Dental for a specific treatment or service. A Participating Dentist cannot charge you or your Dependents for the difference between this amount and the Maximum Approved Fee. Summary of Dental Plan Benefits A description of the specific provisions of your group dental coverage. The Summary of Dental Plan Benefits is and should be read as a part of this Certificate, and supersedes any contrary provision of this Certificate. This Plan The dental coverage established for Members pursuant to this Certificate and your Summary of Dental Plan Benefits.
