Become a Delta Dental Smiles for Kids Provider
Delta Dental administers the Arkansas Medicaid dental program under the names of Delta Dental Smiles and Delta Dental Smiles for Kids. We are thrilled to partner with providers across the state to help more Arkansans receive quality oral health care.
The great news is that as a Delta Dental Smiles and Delta Dental Smiles for Kids participating dentist, you have:
- 24 hour access to all of our online services through the Dental Office Toolkit.
- Fast and efficient processes for pre-authorizations and timely claims processing.
- Dedicated Professional Relations Department to assist you and your office staff.
- Access to excellent customer service department.
Delta Dental Smiles Provider Forms and Resources can be accessed from the "Announcements" section of the Dental Office Toolkit. Click here to login and view the Smiles Provider Manual, Smiles Forms, and other useful resources.
How to Join
Joining the Delta Dental Smiles network is simple!
If you are a current participating network dentist with Delta Dental of Arkansas, contact our Professional Relations staff at (501) 992-1710 to request an amendment to your existing network contract and enrollment form.
You can return the completed documents by:
FAX – (501) 992-1867
Delta Dental of Arkansas
Attn: Smiles Network
PO Box 6247
Sherwood, AR 72124
If you are not already participating in the Arkansas Medicaid dental program, you will need our provider enrollment packet and a Medicaid provider number. Contact us at 501-992-1710 and our friendly staff will help guide you through the process.
For More Information
Our Professional Relations staff is also available to schedule a visit to your office to answer any questions that you may have.
If you need assistance with billing, preauthorizations, access to the provider manual, and access to our secure electronic claims submission portal please log in to our Dental Office Toolkit by clicking Toolkit Login at the top of this page. Click register to create an account. If you need further assistance call our customer service department at 1-866-864-2499.
If you are unsatisfied or have any other issues, we encourage you to discuss them with our Professional Relations Department or Customer Service Representatives. In the event you are unhappy with the results you can file a grievance. Click here for more information.
If you have any questions or concerns, please contact Provider Relations at firstname.lastname@example.org or (501) 992-1710.
Medicaid 101 Webinars: AFMC will host a Medicaid 101 webinar each month. Each webinar is scheduled from 9:30 - 11:00 a.m. on the dates below. A registration link will be added for each session closer to its date. Click here for more information.
- Provider Enrollment Tools
- Who’s Who at Medicaid
- Billing Matters (eligibility strip, provider manuals, websites, and resources)
- Things to know (capitated fees, timely filing, how to submit pseudo claims and benefit plans)
- Contacts (PAC, EDI Support Center and provider rep map)
- HealthCare Portal – features and brief demo (eligibility strip, how to access RA, check status, request PA)
Why did Delta Dental of Arkansas decide to participate in the Medicaid Program?
The answer is simple – it aligns with our mission to improve the oral health of Arkansans.
As the largest standalone dental benefits administrator in Arkansas, Delta Dental of Arkansas brings innovation and forward thinking technology to the Medicaid dental program through our team of expert staff, efficient claims systems, and existing relationships with dentists across the state.
Is Delta Dental Smiles a separate network from Delta Dental Premier and PPO? How does this work?
Yes, the Delta Dental Smiles network is separate from our Premier and PPO networks. However, all of our networks offer the same great features including 24-7 access to our online toolkit, fast and efficient process for preauthorizations and timely claims processing.
How do I apply to become a Delta Dental Smiles provider?
If you are already a participating network dentist with Delta Dental of Arkansas, joining the Delta Dental Smiles network is simple. Call Professional Relations at 501-992-1710 or email email@example.com to receive the contract amendment and other important information.
If you are not a Delta Dental of Arkansas participating provider, we invite you to apply to join the Delta Dental Smiles Network. Call Professional Relations at 501-992-1710 or email firstname.lastname@example.org to receive the contract and important information.
To participate in the Delta Dental Smiles or Delta Dental Smiles for Kids networks, you must be enrolled as an Arkansas Medicaid Provider and have an active Medicaid Number. All providers are required to re-enroll in the Medicaid program every five years thereafter. For tips to ensure that your Medicaid provider enrollment or re-enrollment application process is as seamless as possible, please visit the ARMedicaid web site.
How long does the credentialing process take?
Delta Dental is committed to completing its credentialing process within 7 business days of having all the information we need in order to evaluate the application. The process of obtaining a Medicaid registration number through DHS can generally take up to 45 days.
Are preauthorizations mandatory?
Some dental procedures require preauthorization, for example, orthodontia. However, Delta Dental has reduced the number of procedures that have in the past required a preauthorization. You will find a list of the procedures that need a preauthorization in your Provider Manual. Delta Dental has processes to increase the efficiency for submitting a pre-authorization and the turnaround time for making a decision on the request.
Does the appeals and reconsideration process for Delta Dental Smiles claims mirror the current Delta Dental process?
The process for dentists seeking to have a claim reconsidered or appealed is similar to Delta Dental’s current processes for its commercial business. For example, claims are reviewed by licensed Arkansas dentists located in the state. However, just as dentists can do today in the Medicaid program, there is an opportunity for dentists to seek a review through the Department of Health.
Does the Delta Dental Smiles network have a separate provider directory from the Delta Dental commercial network?
Yes, there is a separate provider directory for Delta Dental Smiles members to find dentists participating in the Delta Dental Smiles network.
Who should I contact if I have additional questions about the Delta Dental Smiles network?
Our Professional Relations staff is available to address any questions or concerns that you may have. Please contact us at email@example.com or (501) 992-1710.
Can the dentist collect the difference in cost from the Delta Dental Smiles member for posterior composites, crowns, or dentures?
Questions about payments for posterior composites, crowns and dentures continue going into the new managed care Medicaid dental program.
Delta Dental will continue the previous approach taken by DHS with respect to posterior composites. The current DHS dental provider manual (Sec. 219.100 and 219.200) states:
“If a provider chooses to do posterior composites, reimbursement will be given at the amalgam reimbursement rate.”
Under state and federal Medicaid rules, dentists cannot collect from the Delta Dental Smiles member the difference between the dentist’s charge for the posterior composite and the amount paid by Delta Dental.
Porcelain and Ceramic Crowns
Delta Dental’s Provider Manual currently states:
"D2929 --- Prefabricated porcelain/ceramic crown, primary tooth, or D2934, prefabricated esthetic coated stainless steel crown, primary tooth, may be performed and submitted, but will be alternated and covered as a D2930, prefabricated stainless steel crown, primary tooth."
DHS has advised Delta Dental that a D2934 can be billed and paid at the D2930 rate. The Delta Dental Smiles member cannot be billed for the difference in cost.
However, DHS has further advised that a D2929 cannot be billed under the current plan. Delta Dental is committed to continuing to work with DHS in the coming months to address this additional code.
Necessary modifications to reflect this change will be made to the Delta Dental Smiles Provider Manual and distributed to all participating dentists.
Stainless Steel Crowns
Effective 08/20/2018, the time limitation for stainless steel crowns (D2930, D2931) for children age 20 and below has been updated to 2 years. Any crowns placed on 08/20/2018 and after will be processed based on this new rule.
The time limitation for adults age 21 and above will remain at 5 years for all crowns.
For removable prosthetic cases, the dentist will bill D5110 and D5120 for full dentures. Removable complete dentures are covered once per arch in a lifetime.
The fee for each of these codes is $474 and does not count towards the member’s $500 annual maximum benefit. The provider is responsible for any adjustments and exams during the first 6 months following delivery.
Immediate dentures are not covered benefits under the Delta Dental Smiles program. More information can be found in the Smiles Provider Manual pp. 3-11, 12 and 7-38-40.
What is going to happen to the prior authorizations pending with DHS that have not been decided prior to January 1, 2018?
Prior authorizations pending with DHS that have not been completed by January 1, 2018 will have to be re-submitted to Delta Dental if the procedure requires a prior authorization.
How can a dentist identify the Delta Dental Smiles members for whom the dentist is the primary care dentist (PCD)?
Delta Dental will provide a list upon request.
Are Delta Dental Smiles for Kids orthodontia patients required to get a cleaning every 6 months from their primary care dentist (PCD) or other treating dentist?
This is not required, but it is preferable so the treating dentist maintains visibility into their patient’s treatment progress and is able to monitor their oral hygiene status during orthodontic treatment.
If DHS approves a patient for orthodontia in 2017, but the patient does not start treatment until January 2018, who pays for the services?
Delta Dental will be responsible for the cost of the orthodontia services under this scenario since treatment did not begin until after January 1, 2018. If treatment does not begin prior to January 31, 2018, the prior authorization process will have to be re-started.
Can a Medicaid beneficiary change managed care organizations after their 90 day “switch” period expires?
Under limited circumstances, the beneficiary may be allowed to switch plan after the 90 day switch period. DHS makes the decision and is establishing the rules around these circumstances.
If a Medicaid beneficiary notifies DHS s/he wants to switch managed care organizations (MCOs), how long does it take for DHS’s systems and the managed care organization’s systems to reflect this change?
We understand that the effective date of a change will be the first day of the month following DHS’s completion of the switch process. While the switch process within DHS is not lengthy, the timing of the beneficiary’s decision to request the switch can affect the effective date of the switch. We would encourage dentists and their offices to verify a beneficiary’s MCO via the MMIS if there are any questions or concerns at the time of treatment.
Are immediate dentures a covered service?
How can a dentist correct an error on a claim? How much time does the dentist have to correct an error?
Once a payment run has been generated by Delta Dental, correcting an error on a claim can be done through submission of a corrected claim by paper or through a call to our Delta Dental Smiles customer service line. Payment runs depend on how the claim is submitted, but can be as soon as the end of the same business day the claim is filed.
If a dentist submits a prior authorization for an orthodontia case and the treatment is approved, but the Delta Dental Smiles for Kids member goes to another office for treatment, can the dentist who submitted the prior authorization be paid for the initial workup?
Yes. Delta Dental will pay that dentist for the initial workup.
Can a dentist bill and collect from a Delta Dental Smiles member for a service if the member has exceeded their benefit maximum?
Consistent with current DHS rules, a Delta Dental Smiles member is responsible for charges for non-covered services, including services received in excess of Medicaid benefit limitations, but only if the member has chosen to receive and agreed in writing to pay for those non-covered services in advance of the treatment.