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 deploys both automation and specialist judgment strategically. Our RPA 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. That combination drives our first-pass acceptance rate to a consistent 98%.
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; identifying underpayments that look like accepted claims but quietly erode collections over time.
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; we route every claim correctly.
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, which means our incentives are aligned with yours from day one.
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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 |
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.
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.
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
*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.
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 22 MRSA § 1711-C-compliant from day one.
Pay only a percentage of what we collect for you
