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A predetermination of benefits is a written estimate from your dental insurer of the amount your dental plan will pay for a specific treatment based on information provided by your dentist.
SDC's predetermination process is helpful for both the patient and the treating dentist. Predeterminations ensure the proposed service is covered by the dental plan and allows you, the patient, to understand what your financial responsibility will be. Since documentation requirements are satisfied before treatment begins, predeterminations can also expedite claim payment.
You can ask your dentist to submit a predetermination of benefits to SDC for any treatment or service before it is performed. It is necessary for a dentist to submit a predetermination when a proposed treatment plan exceeds $400.00 or includes periodontal treatment. Once your dentist submits a predetermination form to SDC, it will be reviewed by SDC's dental consultants (who are licensed dentists), estimated benefits will be determined, and the predetermination of benefits document will be generated and mailed to both you and your dentist.
Scheduled maintenance is currently being performed to Superior Direct Connect and the SDC Mobile App. During this time, you may experience delays in functionality. We apologize for any inconvenience. For immediate assistance during business hours (Monday-Friday, 7:30am – 5:00pm), please call (800) 762-3159.
Scheduled maintenance is currently being performed to Superior Direct Connect and the SDC Mobile App. During this time, you may experience delays in functionality. We apologize for any inconvenience. For immediate assistance during business hours (Monday-Friday, 7:30am – 5:00pm), please call (800) 762-3159.
In 2009, the National Health Care Anti-Fraud Association (NHCAA) estimated that 3-10% of the nation's annual benefits paid for health care were paid for fraudulent or abusive submissions. Estimations by fraud analysts indicate that there is a greater percentage of fraud in dentistry than there is in medicine. Because insurance fraud significantly impacts the cost of dental benefits, you can play a key role in identifying and reporting suspicious activity.
The NHCAA reports that the most common fraudulent acts include:
The close monitoring of processed claims via Superior Dental Care's (SDC's) secure web access (Superior Direct Connect: www.superiordental.com/directConnect.htm) is one easy way to monitor submitted and received claims. If you are aware of any false information submitted to SDC, please contact our Dentist and Member Services Team at 937.438.0283 or 800.762.3159 to report the activity. If preferred, a written complaint may be mailed to: Superior Dental Care Alliance Inc., Special Investigating Unit, 6683 Centerville Business Parkway, Centerville, OH 45459.
SDC's Special Investigating Unit handles all reports of suspected fraud expeditiously and with confidentiality. Reports are accepted anonymously; but, every report initiates an investigation. SDC takes necessary actions to report confirmed fraudulent activities to appropriate state agencies and to recover monies paid in association with misrepresented services.
ORAL HEALTH and RESOURCES (Members)
HUMAN RESOURCE ASSOCIATIONS (Employers)
INSURANCE ASSOCIATIONS (Brokers)
DENTAL ASSOCIATIONS (Dentists)
Last year, SDC completed the integration of our data systems with our parent company, Medical Mutual. This process included replacing SDC's member ID numbers (also referred to as "SDC alternate ID numbers") with new member ID numbers from Medical Mutual.
As of August 2023, all members have received a new ID card with their new member ID number. Since then, we have temporarily continued to accommodate claim submissions that included a retired SDC member ID number. Effective April 1, 2024, retired SDC alternate member ID numbers will no longer be accepted. HIPAA 277 transactions will be initiated, requiring the active member ID number for all claim submissions and member communications.
The active member ID number can be found on the member's new ID card. As a reminder, members may present an SDC ID card or a Medical Mutual ID card. Review the SDC Member ID Card Guide for Providers for reference. Participating dentists may also verify the member ID number through Superior Direct Connect. If you have questions or need assistance, please contact SDC’s Dentist and Member Services team at 1-800-801-4915.
Thank you for your attention to this critical submission requirement.
