Clinical Policies Disclaimer | Providers

Clinical Policies

Delta Dental of Virginia’s Clinical Policies

Delta Dental of Virginia’s clinical policies provide transparency with respect to the clinical criteria that might be required for the processing of certain claims.  Related issues include the criteria needed to establish dental necessity, whether certain claims are primarily cosmetic, and the identification of procedures or supplies that are considered to be experimental. Compliance with the clinical criteria set forth within these policies is not a guarantee of payment or that a service or supply is covered by a particular dental plan or policy.

The enrollee’s dental plan is the primary source to determine whether any particular service or supply is covered.  Specifically, each dental plan or policy will contain: (i) a description of covered benefits; (ii) a list of benefit exclusions; (iii) a list of benefit limitations; (iv) maximum allowances; and other limitations.  In the event there is a conflict between a particular dental plan or policy and the Delta Dental of Virginia clinical policies, the particular dental plan or policy will control.

The clinical policies are created based on analysis of peer reviewed literature, expert dentist opinions, consensus or position paper statements, and evidence based guidelines from nationally recognized dental organizations. Those organizations include, but are not limited to, the American Association of Oral and Maxillofacial Surgeons, the American Association of Periodontists and the American Association of Endodontists.

Delta Dental of Virginia’s policies do not constitute professional clinical advice.  Treating providers are solely responsible to subscribers for diagnosis, care, and treatment.  Any decision whether to provide a service is the treating provider's decision, and any decision whether to receive a dental service is the subscriber’s decision, regardless of whether the service is a covered benefit.

Delta Dental of Virginia’s clinical policies are updated on a regular basis and, therefore, subject to change. At a minimum, we recommend that you check the policies on an annual basis for updates.   We welcome any comments and hope that the information contained within the policies is useful.  Please forward all comments or articles to be considered to Delta Dental, attention Dental Director.