Delaware’s three competing Medicaid MCOs, Delta Dental-anchored commercial market, and State Board of Dentistry and Dental Hygiene regulatory framework leave most out-of-state vendors unprepared. TransDontics’s 1,100+ Delaware-credentialed specialists manage your complete revenue cycle so your collections stay optimized.
Delaware distributes over 250,000 Medicaid members across three MCOs; AmeriHealth Caritas through DentaQuest, Highmark Health Options through United Concordia, and Delaware First Health through Envolve Dental, each with distinct credentialing, prior auth portals, and adjudication timelines. Delta Dental, Highmark BCBS, and Aetna add further commercial complexity
Delaware's Three-MCO Medicaid Structure
AmeriHealth Caritas Delaware & DentaQuest Dental Benefits
Highmark Health Options and Delaware First Health
Delta Dental of Delaware's Dominant Commercial Footprint
TransDontics’s 1,100+ in-house dental billing specialists are supported by RCM automation engineered for Delaware’s dental billing environment. Every process is designed around the actual payer rules, fee schedules, and documentation standards your claims will face.
TransDontics deploys both automation and specialist judgment strategically. Our RCM automation handles eligibility checks across all three Delaware MCOs, claim scrubbing, portal submissions, and payment tracking. Our specialists manage appeals, prior authorization follow-up, and COB reconciliation.
Every payment reconciled against your contracted rate across every payer. When Delta Dental, Highmark BCBS, or any Delaware MCO pays below the agreed fee, we flag it and appeal within 14 days. Most practices only catch outright denials. We go further.
Before every Delaware Medicaid claim goes out, we confirm MCO enrollment, verify the applicable DSHP plan, format to that MCO's protocols, and attach required prior authorization documentation. AmeriHealth Caritas, Highmark Health Options, and Delaware First Health adjudicate differently.
Claims processed within 48 hours of receipt. No setup fee, no monthly minimum, no long-term contract, and no hidden costs buried in the fine print. Our fee is a nominal percentage of what we successfully collect from payers on your behalf. We only earn when you get paid.
Expert CDT coding, clean claim submission, and aggressive denial management by specialty-certified billers. 98% first-pass clean claim rate.
No claim goes 48 hours without follow-up. We pursue every outstanding balance across all payers until it is paid, appealed or written off.
Get in-network faster. We handle all payer paperwork, CAQH maintenance, renewals, and compliance tracking so you start seeing insured patients.
Full revenue cycle coverage from patient registration to final payment. We manage all claims, close every gap, and maximize your collections.
Strategic oversight of your practice’s operational and financial performance. We track collections, payer mix, and productivity metrics
Complete front office billing support covering patient billing inquiries, insurance comms, prior auth, and appointment-linked verification.
HIPAA-compliant dental transcription delivered fast and accurately. Clinical notes, procedure documentation, and patient records are transcribed.
We review your last 12 months, find your top 3 revenue leaks, and show you exactly what we fix. Practices often discover recoverable revenue.
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An in-house biller knows your practice; not AmeriHealth Caritas’s extended benefit criteria, Highmark Health Options’ COB protocols, or Delaware First Health’s prior authorization triggers. Turnover resets that knowledge.
Most billing companies submit claims. They won’t reconcile every EOB against your contracted rate, flag MCO underpayments, identify benefit cap gaps before service is rendered, or chase uncollected revenue.
Most billing companies are a service. TransDontics is a system: RPA catching what humans miss at volume, experienced billers catching what automation cannot judge. The result is a first-pass acceptance rate of 98%.
Three steps. No disruption. No risk.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
Three steps. No disruption. No risk.
We review your claims, A/R, and denial patterns at zero cost. Most practices find 5–10% in hidden revenue leakage.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
We don’t publish named case studies because most clients prefer to keep billing performance private. What we can share is what the numbers look like across practices with comparable payer profiles.
Based on aggregated results across dental practices in comparable payer environments.
| Metric | Before TransDontics | After TransDontics |
|---|---|---|
| Average Denial Rate | 8–12% | Under 2.3% |
| First-Pass Clean Claim Rate | 70–80% | 98% |
| A/R Over 90 Days | 30–40% of Total AR | Reduced by 30%+ |
| Average A/R Resolution | 45+ Days | 18–25 Days |
| Claim Turnaround | 3–5 Days | 48 Hours |
| Revenue Growth (120 days) | Baseline | 5–12% Increase |
A Wilmington practice came to us with an 11% denial rate, 35% of A/R past 90 days, and Medicaid claims rejected for MCO assignment errors with AmeriHealth Caritas submissions routed to Highmark members and vice versa. Front desk spending 2–3 hours daily.
Our specialists know every Delaware payer’s rules and appeal processes. National billing companies stumble on Delaware’s three-MCO structure with wrong portal submissions and missing DSHP-Plus documentation. We don’t.
Highmark’s dual role as Medicaid MCO and commercial payer creates billing complexity most practices aren’t prepared for. We manage both as fully separate workflows.
Employer group presence among technology and professional services employers. Cigna’s 90-day timely filing window demands active tracking. We flag claims approaching the threshold and prioritize them.
Anchors Delaware’s commercial employer group market. Custom benefit designs and COB requirements generate above-average denials without separate billing tracks. We manage all plan types with full protocol compliance.
Whatever dental insurance your practice accepts, we ensure you get paid. TransDontics’ billing experts navigate the complexities of every major dental insurance network to maximize your revenue.
TransDontics handles Delaware claims daily, knowing Delta Dental PPO versus DeltaCare HMO differences, separate DSHP credentialing processes, and Wilmington’s unusually diverse commercial payer mix.
Every Delaware practice qualifies. If your city isn’t listed, it’s coming. Reach out now and we’ll onboard your practice without delay.
Every state has its own payer rules, Medicaid structure, and billing landmines. TransDontics expertly navigates all of them.
Delaware practices carry HIPAA obligations alongside 24 Del. C. Chapter 11 and three Medicaid MCO documentation standards. TransDontics is independently HIPAA certified and SOC 2 Type II compliant statewide.
All patient data is encrypted end-to-end, satisfying HIPAA Security Rule technical safeguards and Delaware patient privacy requirements under 24 Del. C., Chapter 11. Every data transmission meets the highest applicable standard; not just the minimum.
Only credentialed TransDontics personnel can access your practice data, eliminating the internal access vulnerabilities that turn in-house billing into a compliance liability most Delaware practice owners don't realize they're carrying until it's too late.
Our AICPA SOC 2 Type II certification is independently audited and renewed annually. Everything is documented and third-party verified, providing proof of our security posture. Your Delaware practice's liability exposure is measurably reduced from day one of our partnership.
Customized billing solutions based on your specialty
Average Delaware salary
Benefits + Payroll Taxes
Software + Training
Turnover Cost
Average Denial Rate
First-Pass Clean Claims Rate
Setup Fee
Contract
~$44,000/yr
~$13,000/yr
~$5,000/yr
~$60,500/replacement
8–12%
70–80%
—
—
Included
None
Included
None
Under 2.3%
98%
$0
Cancel Anytime
*Salary benchmarks based on Delaware BLS/ZipRecruiter data. Results vary by practice size and payer mix.
Our Complimentary audit covers denied claims, MCO routing errors, and underpayments, no obligation, no pitch.
Specific, verified outcomes, not generic praise. Every metric sourced from client data.
In the first 60 days, TransDontics recovered $18,400 in claims our team had written off as uncollectable. They caught 47 denied claims we had given up on. The Dentrix integration was seamless as they were billing the same day.
General Dentist · Austin, TX
I was spending 3 hours a day chasing orthodontic claims. TransDontics took over and our denial rate dropped from 22% to under 4% in three months. The multi-visit treatment plan billing alone recovered $31K we had been losing annually.
Orthodontist · Los Angeles, CA
We run 3 oral surgery locations on Eaglesoft. The OMS anesthesia cross-coding was a mess; TransDontics cleaned it up in week one. Collections are up 11% across all three locations.
Oral Surgeon · Dallas, TX
RCM automation handles MCO eligibility checks, claim scrubbing, portal submissions across all three Delaware Medicaid MCOs, and payment posting automatically. Specialists manage appeals, EOB reconciliation, prior authorization follow-up, and payer escalations. That combination drives a consistent 98% first-pass acceptance rate neither layer achieves alone.
TransDontics charges a small percentage of what your practice successfully collects from insurance payers. No upfront fees, no monthly retainers, no hidden charges. If you don’t collect, we don’t earn. Our financial incentive is always aligned directly with your practice’s revenue performance.
No setup fee. No monthly minimum.
Cancel anytime.
Response within 24 hours.
HIPAA and 24 Del. C., Chapter 11-compliant.
Pay only a percentage of what we collect for you
