All product names and trademarks are the property of their respective owners, which are in no way associated or affiliated with MouthWatch. Product and software names are used solely for the purpose of identifying specific products with which MouthWatch Intraoral Cameras will integrate. Use of these names does not imply any co-operation or endorsement.
Teledentistry (“TeleDent™”) Pilot for DDMA Providers
Terms & Conditions
Pilot Description
Delta Dental of Massachusetts (DDMA) is dedicated to improving the oral health of its members. DDMA’s efforts are supported by its affiliate companies including, CareQuest Institute for Oral Health, Inc. (collectively “CareQuest”), whose mission is to use data-driven insights to identify and solve oral health’s most vexing problems. CareQuest furthers this mission by investing in emerging products, technologies, services, and potentially disruptive business models that have the power to revolutionize oral health access and outcomes for underserved populations in the United States.
CareQuest has identified MouthWatch’s TeleDent as a teledentistry technology that has the potential to greatly improve oral health access and outcomes for underserved populations, particularly during a time when the COVID pandemic has made it more difficult for patients to receive in-person dental care. In particular, CareQuest believes that TeleDent will increase convenience of and access to dental care for patients, improve prevention and outcomes, and decrease overall cost of dental care.
For this reason, CareQuest has invested in MouthWatch and made arrangements for certain dentists in DDMA’s network to participate in the TeleDent pilot for use with their DDMA commercial patients.
Importantly, dentists in DDMA’s network are not required to use TeleDent and will not be penalized or disadvantaged in any manner if they choose not to use TeleDent or use a technology similar to TeleDent. DDMA will be collecting and analyzing portal data from the use of TeleDent to obtain information about the utility of teledentistry.
The pilot program will provide participating offices and their patients with access to TeleDent – a smartphone friendly teledentistry platform – that includes secure patient messaging, live video conferencing, secure file sharing, and cloud collaboration that helps to improve clinical workflows, referrals, and PPE conservation measures. Patients will be able to access TeleDent via mobile or desktop, where they can video chat with providers through their smartphone, tablet or computer.
During the Pilot
During the 6-month duration of the pilot, providers can make the TeleDent platform available to their patients for use of services as they see fit and per clinical guidance (see below). CareQuest Innovation Partners will cover the cost of the subscription for the length of the pilot and for 6 months post pilot (a full year subscription)
Providers should adhere to the reimbursement guidelines provided by DDMA, their provider agreement with DDMA and all DDMA policies and procedures including the Participating Provider Procedure Manual and Provider Manual.
All benefits mentioned within this agreement are available solely to participating DDMA providers.
Clinical Guidelines
For the pilot, DDMA will provide reimbursement under the limited services code. Below is a full description of our reimbursement guidelines for TeleDent.
- Please use the appropriate CDT code when submitting an oral evaluation
- If it is determined a limited oral evaluation is completed as described by the nomenclature and descriptor of the appropriate CDT Code, then D0140 should be documented and submitted for payment. DDMA only reimburses the D0140 and payment is determined based on the member’s specific available benefits.
- When D0140 is reimbursed by DDMA it will be counted toward any benefit limitations that the member’s specific policy may have. Typical plan designs allow for two D0140 per patient per benefit year. Please explain these benefit limitations to your patients.
- A separate fee for D9995 (teledentistry synchronous) or D9996 (teledentistry asynchronous) is not reimbursed by DDMA and is not billable to the patient.
- The Provider should also consider using teledentistry technology for services that may not be reimbursed but can be safely and effectively delivered using the teledentistry technology (e.g. “follow up” after certain procedures).
- Please remember the ADA’s position on coding – “Code for what you do and do what you coded for.” Services delivered should be consistent with in-person services in the professional judgment of the dentist.
- As always, the Provider should bill the appropriate code for the service that was provided, although only code D0140 is reimbursable as part of the pilot.
Training Providers
Each provider location will be assigned a Client Success Manager, a dedicated TeleDent representative that will coordinate with each location a time to provide custom training sessions on managing and using the platform.
Additional Expectations of Providers
- We ask that providers participate in pre and post pilot survey and a feedback session, hosted between MouthWatch and DDMA, that will gather qualitative usage data on the successes, challenges and experiences of TeleDent so that DDMA and MouthWatch can better understand how the platform integrates into the workflows of various providers.
- It is critical that providers inform patients that any services/visits received through TeleDent count towards the patient’s benefit limits for said services.
- In addition, during the TeleDent pilot, The TeleDent platform is not intended for use with Medicare/Medicaid/SCO/CHIP or any other government program. By participating in the Pilot, the provider is agreeing not to utilize the TeleDent Platform with Medicare, Medicaid (MassHealth, SCO/CHIP), or other government program members during the Pilot period.
Pricing (After the 6-Month Pilot)
For six months following the Pilot end date, providers will be able to continue using TeleDent for an additional six months after the pilot end date without cost. If providers continue to use TeleDent after the pilot end date, they will be provided the same exclusive benefits and services at no additional costs, which include:
- Additional 10 GB storage
- Bulk patient upload service (takes place via Client Success Manager)
- CE Certificate Program for Teledentistry Consultations
- Priority Onboarding for Groups/Practices
- Dedicated Customer Success Manager
- Prioritized Phone Support Number
- Prioritized Feature Requests
- Orientation and Follow up Trainings/Consulting
- Tailored in-app training, tool tips and guides where applicable
- Tailored Learning Courses specific to DDMA needs
- Teledentistry Toolkit (Resources for Marketing, Coding, Etc.)
Following the 6-month post-Pilot period, should a provider wish to continue using the TeleDent services, they may elect to continue their subscription according to the MouthWatch subscription pricing then in effect. Current pricing is included in the table below.
For offices that need a larger number of accounts, MouthWatch will offer subscription discounts based on volume. This tiering structure can be found in the table below.
These pricing and other terms are confidential and should not be shared with other providers or dental organizations.
| TeleDent Professional | MSRP* |
| Initial 2-Users | $109.00 |
| Each Additional User (up to 10) | $15.00 |
| Each Additional User (up to 20) | $14.00 |
| Each Additional User (up to 50) | $13.00 |
| Each Additional User (up to 100) | $12.00 |
| Storage (each 10 GB – $10 per month) (10 GB included for DDMA) | $10.00 |
*All prices shown are monthly fees. Rates as of 9/1/2021 and subject to change in MouthWatch’s discretion.
Reporting
A main objective of this teledentistry Pilot is to gain insights and understand the integration of TeleDent into the workflow of the providers, as well as the successes and challenges that teledentistry has amongst various provider groups. One way of achieving this is by analyzing usage metrics of the platform. MouthWatch will track monthly usage reporting related to how the TeleDent platform was used including, the number of appointments scheduled by providers, duration of visits, and metrics related to the performance of the platform (e.g., time-out rate, bounce rate, connection speed, etc.).
Additionally, qualitative and quantitative platform usage data will be gathered through the provider feedback sessions. No service-, patient-, or practice-specific information will be requested or reported upon.
Disclosure of DDMA-MouthWatch Relationship
Please note, that DDMA is not endorsing MouthWatch and/or its TeleDent product. Each provider should speak to MouthWatch and determine if TeleDent is a proper fit for their practice. Additionally, in the interest of transparency, we note that CareQuest Institute for Oral Health, Inc., an affiliate of DDMA, is an investor in MouthWatch. This offer is not conditioned upon, or intended to induce, any referral by any party or its employees or agents to any other party. The terms of this offer do not reflect the volume or value of any business generated between the provider and DDMA. No aspect of your participation in any DDMA provider network will be impacted by your acceptance or denial of this pilot offer.
Patient Consent Language
Should a provider wish to add their own language to the Provider-Patient consent form, MouthWatch must properly review the changes and approve before distribution to the patients.
Entity name:
Tax ID Number:
Owner’s Name:
Owner’s Signature:
By signing this document, I hereby agree to and acknowledge the terms and conditions as they have been described.
Date: