Reimbursement-Adjusted Denture Pricing Program

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    *For qualifying insurance-covered cases. Credit is issued upon EOB submission and approval

Overview

Care for more patients while protecting your bottom line. 

Dandy’s Reimbursement-Adjusted Pricing Program offers discounted rates on Final Full and Partial Dentures when insurance reimbursement falls below $750 per arch. There’s no enrollment process or paperwork required. Simply submit proof of insurance allowed amount through the Dandy Portal to receive credit.

This guide outlines eligibility, how to submit documentation, and where to track your submission status.

What’s Included

• No enrollment required
• Final Full & Partial Dentures are eligible
• Submit “Proof of Insurance” documents directly in the Dandy Portal
• Receive approvals within 7-10 days, and credits within 30 days
• New Insurance Tab (found in Portal - not Chairside) to manage submissions and track statuses
• Same high-quality materials and turnaround times

Eligible Products & CDT Codes

Turnaround times: 7–12 business days

Ineligible Products

Submission Summary

• Medicaid plans: 
  • No proof needed → system auto‑verifies and auto‑credits based on internal allowed amounts
  • Video Summary - Medicaid Plans
• Non‑Medicaid plans:
  • Proof still required (eligibility check or EOB) → requests go to the Pending tab for manual review
  • Video Summary - Non-Medicaid Plans

**Periodically, practices may experience Automation issues: requests show in Auto Failed Credit tab for manual review

Step-by-Step Instructions

Step 1: Place an Eligible Order

Submit any qualifying final full or partial denture case as usual via the Dandy Portal or Chairside.

Step 2: Select an insurance plan

  Select provider, enter whether in or out of network, and state of coverage

Step 3: Select Eligible Order

Step 4: Submit Proof of Insurance

Dandy offers two simple submission options in the Dandy Portal:

• Watch the 2-minute walkthrough video

Option 1: Document Upload (All Patients)

Upload a redacted Explanation of Benefits (EOB), Pre-Authorization Approval, or other Proof of Insurance document to begin the review process.

Document must include:

• Patient Name
• Patient Date of Birth
• CDT Code(s) (e.g., D5110, D5211)
• Total Billed Amount
• The insurance allowed amount is under $750 per arch

Option 2: Eligibility Check (Medicaid Only)

Submit basic patient and provider information for automatic insurance verification.

Required Fields:

• Insurance Provider
• Member ID
• Patient Name & DOB
• Practice NPI and Tax ID (only required once)

Optional Fields:

• Group Number

Reimbursement requests may be submitted for:

• Final Full Dentures ordered on or after April 30, 2025
• Final Partial Dentures ordered on or after July 1, 2025
• Within 90 days of the original order date

Step 5: Request Insurance Check

Step 6: Track Case Status

The Insurance Tab in the Dandy Portal provides a centralized hub for submitting and managing your reimbursement-adjusted denture cases.

You can:

• Submit proof of insurance
• Track the status of denture and partial orders from the past 90 days
• Filter by case status: Eligible, Pending, Approved, Credit Applied, Denied

Tab Definitions

• 🟢 Eligible: Orders that may qualify; submit proof to begin review
• 🕓 Pending Review: Proof submitted and under review; no action needed
• ✅ Approved: Documentation approved; credit is processing
• 💰 Credit Applied: Credit successfully issued to your account
• 🔴 Denied: Case ineligible (e.g., allowed amount exceeds $750/arch)

Tip: Use built-in filters to quickly find the status of any submission.

FAQs

Do I need to enroll?

• No. Submitting an EOB through the portal counts as agreement to the program terms.

Are partial dentures included?

• Yes. Acrylic, Flexible, and Chrome Cobalt removable partial dentures (RPDs) are all eligible. Titanium units are the only exception.

Does the Reimbursement Adjusted Denture Pricing Program only apply to in-network insurance plans?

• No. The program applies to any payer—whether in-network or out-of-network—if the allowed amount for applicable CDT codes is less than $750 per arch.

Can I submit the EOB after delivery?

• Yes. You can upload the EOB anytime once it becomes available.

Is the product quality the same?

• Yes, quality remains the same. You’ll receive the same full and partial denture products Dandy is known for, crafted with industry-leading materials and workflows. Orders are completed in 7–12 business days, depending on the product type, at a fraction of the standard cost.

How can I learn more about pricing?

• We understand how important pricing is when making decisions. Book a demo through our solutions page to explore the reimbursement adjusted pricing denture program in detail, or contact your account manager for a personalized estimate tailored to your practice.

Support

Live Chat

• Chat: Open Practice Portal > Type "hello" > Select "Billing Help"

Email

• dentures@meetdandy.com

Additional Resources

• Watch the walkthrough