Delta responds to ADA inquiries about charging dentists to receive reimbursement

Association provides support to members wishing to adopt EFT

The American Dental Association opposes Delta Dental of California’s policy to begin charging dentists for paper checks and Aetna’s move away from paper checks for noncontracted providers.

This action is in direct conflict with ADA policy, and the ADA believes that dentists should have the freedom to choose their preferred method of payment and receive the full value of their reimbursement without being subjected to unnecessary administrative fees or payment processing charges.

The ADA previously sent a letter July 8 to the National Association of Insurance Commissioners asking the organization to take a stand against this payment policy shift and urging insurance commissioners around the country to support regulatory oversight.

To further support its member dentists, the ADA sent several questions on their behalf to Delta Dental Plans Association and Delta Dental of California. Below are the organizations’ answers to the ADA’s questions.

ADA: How can practices treating Delta Dental-covered individuals access explanation of benefits statements when receiving electronic funds transfer, or EFT?
Delta: All Delta Dental electronic remittance advice statements can be accessed through the national dentist dashboard at deltadental.com. Simply log in and click on the “Check National ERA” tab. Delta Dental has partnered with DentalXChange to simplify the management of the remittance advice statements. You can also access the system through your local Delta Dental member company’s website.

ADA: How can individual claims be traced to bulk EFT payments?
Delta: Delta Dental websites provide details about the claims associated with the payment, including the EFT check number.

ADA: How long does it typically take to receive an EFT payment? Are the explanations of benefits delivered within the same time frame?
Delta: EFT payment cycles vary by Delta Dental member company and may range from daily to weekly. Electronic remittance advice/explanation of payment/remittance advice statements are typically issued no later than one business day after the corresponding payment.

ADA: Can the dental plan withdraw funds from my bank account if, for some reason, a recoupment is requested?
Delta: No. Delta Dental cannot withdraw funds directly from a provider’s bank account. EFT payments are one-way transactions that are securely routed through approved banking channels and support deposits only, protecting providers from unauthorized withdrawals or access. Any recoupments are handled through standard reconciliation processes.

ADA: How does EFT work if I have multiple office locations?
Delta: The provider would need to sign up for each office location. Delta Dental has partnered with DentalXChange to simplify the management of the electronic remittance advice. The electronic remittance advice will capture claims by provider and office location/tax ID. It includes information about the patient, service provider, adjustments made to the claim, procedure performed and cost, including patient benefits, co-payment and deductible information.

ADA: How does EFT work if I have multiple providers in the office?
Delta: The electronic remittance advice/explanation of payment/remittance advice that accompanies every EFT will capture claims for the providers in the office by tax ID. It includes information about the patient, service provider, adjustments made to the claim, procedure performed and cost, including patient benefits, co-payment and deductible information.

ADA: What happens if a deposit is attempted to a closed or incorrect account? 
Delta: When an electronic deposit fails, the Delta Dental member company receives a failure notice. The Delta Dental member company will update the provider to the plan’s default payment method while the member company attempts to secure updated EFT information from the provider.

ADA: Is it possible to terminate EFT enrollment once I have opted in?
Delta: Yes, it is possible for a provider to terminate their EFT enrollment.

ADA: How does Delta Dental determine how I receive payment?
Delta: Providers will be paid according to the method they have selected with their local member company or third-party payment processor if they have contracted with one. Providers can enroll once through their local Delta Dental member company and opt into national EFT, in which case the local member company will make the information available to all member companies for their use in paying the provider.

ADA: How will the $15 weekly fee being imposed by Delta Dental of California enterprise companies work if:

• I am out of network with Delta Dental? 
  Delta: At this time, out-of-network providers are not included in the weekly processing fee. If that changes in the future, Delta Dental will provide advance notice of such change. Out-of-network dentists may enroll in EFT, and Delta Dental encourages all providers to do so.
• I am contracted with one of the Delta Dental of California enterprise companies and I am treating a patient covered by them? 
  Delta: If a provider chooses the paper check option, they will be charged a $15 processing fee weekly by Delta Dental of California.
• I am contracted with Delta Dental of California enterprise companies and I am treating a patient covered by a different Delta Dental member company? 
  Delta: The $15 weekly processing fee applies only to claims submitted to Delta Dental of California enterprise companies by contracted providers within the Delta Dental of California enterprise states at this time.
• I am contracted with a different Delta Dental member company and I am treating a patient covered by a Delta Dental of California enterprise company? 
  Delta: The $15 weekly processing fee only applies to claims submitted to Delta Dental of California enterprise companies by contracted providers within the Delta Dental of California enterprise states at this time. Providers will be notified by their local member company of changes in payment options and any applicable fees.

ADA: What customer support is available for EFT-related issues?
Delta: Each Delta Dental plan has a provider service line to assist with any EFT-related issues. For Delta Dental of California and its member companies, contact the provider concierge at 1-800-592-0156. 

The ADA Council on Dental Benefit Programs also compiled the Q&A below as a tool to assist dentists as they navigate the decision to move from paper checks to EFT. The Association recently updated its EFT implementation checklist as well to support offices choosing to transition. Issues that continue to be reported include:

• Decoupled payment and remittance that arrive via different channels on different days.
• Bulk deposits that obscure claim-level detail.
• Missing or malformed transaction reference numbers in remittance files that do not correspond to bank transaction numbers.
• Addenda records missing from online banking interfaces.
• The use of proprietary portals and PDFs by payers to deliver remittance files instead of standard electronic transactions.

The ADA and state dental associations have successfully advocated for payment choice in many states, and the ADA advises dentists to be aware of laws governing choice in their state when choosing payment options.

Q: Are EFTs free?
A: It depends. The ADA has not yet encountered payers charging a fee for an EFT, but it has encountered complaints from dentists who were directed by dental plans to third-party vendors for payment processing that then applied additional charges. This is typically tied to “value-added” services — such as automatic reassociation, expedited payment or practice management integration — bundled in the enrollment process. Before signing an EFT enrollment agreement, review any added services or ask specifically for a basic, fee-free EFT option. In some instances, the bank that a dentist chooses to work with may charge a fee. 

Q: What can I do to protect my practice and have financial oversight if I sign up for EFT? Do I have to share my banking information with my office staff?
A: A commonly recommended best practice is to establish a dedicated bank account exclusively for receiving EFT payments from payers. To efficiently reconcile payments, your office manager or designated staff member may need access to the account. However, many practices work with their banking institution to establish view-only access rather than full transactional authority. This allows staff to verify deposits and reconcile payments without the ability to move funds.

Practice owners should maintain regular oversight of EFT activity, ideally reviewing deposits and account activity at least weekly. Practices should ask their bank to place a debit block or debit filter on the EFT account so funds cannot be pulled without authorization. Funds can then be transferred from the EFT account to the practice’s primary operating account according to the practice’s established financial procedures. This approach helps balance operational efficiency with appropriate financial controls and oversight. Practices transitioning to EFT may want to consult with an accountant to establish the most efficient, cost-effective workflow for their office.

Q: Are EFT funds typically sent as individual claim payments or in a bulk transaction?
A: EFT payments can come as either, depending on how many claims have been processed at the time the dental plan is making its scheduled payment.

Q: Are explanation of benefits/electronic remittance advice statements sent as bulk statements or individually by claim?
A: The electronic remittance advice is the Health Insurance Portability and Accountability Act 835 transaction and is referred to in paper form as an explanation of benefits, explanation of payment or remittance advice. There is an electronic remittance advice for each EFT, so it may cover one or more claims depending on what is included in the EFT.  

These statements all provide information about the patient, service provider, adjustments made to the claim, procedure performed, and cost, including patient benefits, co-payment and deductible information. If payment is denied, an explanation is provided.

Q: If a provider's banking portal does not display automated clearing house addenda information, what alternative mechanism is available to obtain the reassociation data necessary for payment posting?
A: As part of the EFT enrollment and implementation process, practices should proactively contact their financial institution and confirm that their banking platform can receive and display the automated clearing house cash concentration or disbursement plus addenda information that accompanies healthcare EFT transactions. Dentists should specifically request access to the EFT reassociation trace number and other addenda data needed to match EFT deposits to the corresponding electronic remittance advice for accurate payment posting. If an EFT account is already established but the information is not displayed, offices should request information on how to retrieve the information needed for reconciliation.