Agmt98 Delta Dental - Laserfiche WebLink

Browse Search

-- -- ---- ------ ---- ---- ----- . ---- ---- ---- ARTICLE 8 - OTHER DELTA OBLIGATIONS 8.1 8.2 8.3 8.4 1___- Delta shall encourage Participating Dentists to submit a standardized Attending Dentist Statement (ADS) before providing service, showing the patient's dental needs and the treatment necessary in the professional judgement of the Dentist. Delta shall predetermine, from the ADS and other data, what would be payable by Delta and an Eligible Person for the proposed services under the terms of this program as of the date of predetermination. Such predetermination shall not constitute a guaranty or authorization of Benefits under this Contract, and any actual payment by Delta will depend on the patient's eligibility and remaining annual maximum when completed services are reported to Delta. Delta shall advise Participating Dentists to notify the patient of all information provided by Delta in the predetermination. A Dentist may file an Attending Dentist Statement before treatment, showing the services to be provided to an Eligible Person. Delta will predetermine the amount of Benefits payable under this Contract for the listed services. Predeterminations are valid for 60 days from the date of the predetermination but no longer than the Contract's term nor beyond the date the patient's eligibility ends. Delta will not make any payment for services provided to a patient who is not an Eligible Person under this Contract when the service is provided, except for completion of Single Procedures which were begun when a patient was eligible or was entitled to Benefits under that authorization. City of Redwood City agrees to reimburse Delta for any erroneous payments made as a result of incorrect eligibility reporting by City of Redwood City. Delta will provide professional review of the adequacy of service provided by Participating Dentists. 24