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Medicare Advantage Update for Providers Who Opted Out of Medicare

January 1, 2022

Until recently, providers who opted out of Medicare could not be paid by Northeast Delta Dental for dental services provided to a Martin’s Point Generations Advantage (MPGA) patient.  However, the Centers for Medicare and Medicaid Services (CMS) recently finalized a rule clarifying that Medicare opt-out status no longer applies to supplemental benefits in 2022. 

What does this mean to you?

  • Effective January 1, 2022, providers who have opted out of Medicare will no longer have their claims for MPGA patients denied due to their opt-out status. Claims will pay based on the benefits available under the plan selected by the patients, for the date services are provided, just like any other Northeast Delta Dental group.
  • Claims submitted to Northeast Delta Dental for MPGA patients are processed using the Northeast Delta Dental Premier MAC and PPO fee schedules, not the reduced Medicare fee commonly seen with medical claims submitted to Medicare.
    • MPGA Plan overviews are attached for your reference.
  • Your name and practice location will now be listed as a participating provider when the Martin’s Point Generations Advantage plan is selected on our “Find a Dentist” tool located on nedelta.com.

Please be aware that subscriber ID cards for MPGA patients are different than what you typically see for Northeast Delta Dental patients. Instead of a Northeast Delta Dental ID card, you’ll see an ID card similar to the example below.

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Dental offices can check patient eligibility and benefits online at www.nedelta.com or call our Customer Service Department at 1-800-832-5700.