An alternative to the traditional Medicare program authorized by Part C of Medicare. Health insurance companies or health maintenance organizations provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program. The Centers of Medicare and Medicaid Services (CMS) oversees the Medicare Advantage Program.

As a Delta Dental network provider, you already adhere to most credentialing and re-credentialing requirements. The following are a few additional CMS requirements needed to participate in a MAP.

• Exclusion from the Medicare Preclusion List

• Exclusion from the Office of Inspector General List

• Completion of a Compliance Attestation form – must be completed for each location

• Fraud, Waste and Abuse (FWA) training is required annually for office staff. For your convenience, a FWA training program is available on this page.

• Non-Covered Services - Providers are required to have signed written documentation indicating the member understood and agreed to pay for any non-covered services. A sample non-covered services form is available on this website.

• Directory Accuracy Confirmation - CMS requires Delta Dental to send quarterly audit letters to dentists verifying the information in the directory is correct and up-to-date.

• Members must receive treatment from a MAP network provider to receive benefits.

Delta Dental is required to monitor and ensure your organization operates in compliance with applicable laws and regulations required by CMS and your Participating Dentist Agreement. Each year, you are required to affirm your commitment to comply with each of the listed topics in the attestation that apply to your organization and the services you provide for Medicare Advantage business. The compliance attestation form is available on this website. A compliance form must be completed for each location.

You will receive an email and letter from CMS/Medicare Administrative Contractors in advance of  your inclusion on the preclusion list. The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal. For more information, visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Preclusion-List.

On a monthly basis you need to check the Office of Inspector General’s (OIG) List of Excluded Individual and Entities (LEIE) and the General Service Administration’s (GSA) System for Award Management (SAM) database to make sure dental providers and staff in your office do not appear on any government preclusion/exclusion lists that would prevent your practice from participating in the Medicare Advantage network.

We just need the compliance attestation form and agreement supplement signature page. 

Return the completed compliance attestation form (found on this page) for each location  and signature page to medicareadvantage@deltadentaltn.com or fax to (615) 742-6940. 

Keep the Medicare Advantage Supplement with your current Delta Dental PPO Participating Dentist Agreement.