Notice

Customer Service is experiencing longer than usual wait times. Please bear with us as we work diligently to answer your calls.

Dental Claim Submissions

Proper Submission of Dental Claim Forms

Treatment date

  • Report every date that a dental service was actually performed or completed.
  • Multi-staged procedures such as crowns, bridges, dentures, and root canal treatment should be submitted upon completion of the service.
  • Completion date for fixed partial dentures, crowns, onlays, and inlays is the cementation date regardless of the type of cement utilized.
  • Completion date is the date of insertion for removable prosthetic appliances.
  • Completion date for immediate dentures is the date the remaining teeth are removed and the denture is inserted.
  • Completion date for root canal therapy is the date the canals are permanently filled.

 

Treatment rendered

  • Report each dental service or procedure that was rendered, including— but not limited to— tooth number, surfaces and materials.

 

Coordination of benefits

  • Report any other benefit coverage, insurance payments, and adjustments for the dental services.

 

Disclosure of waiver

  • Insure you clearly disclose on the claim form if there is any intention to waive a patient's co-payment, or any portion of the patient’s co-payment responsibility.

 

Disclosure of discounts

  • Insure any discounts extended to the patient for these services are clearly detailed, including any reduced fees that resulted from the use of coupons or promotions.

 

Disclosure of "free" services

  • Clearly reflect the fee of the services actually being charged and collected from the patient.

 

Services not performed

  • Report only services that are actually performed.

 

Identification of appropriate dentist

  • Insure both the billing dentist and the treating dentist are clearly identified by name and license number.

 

Barter

  • Delta Dental does not make payment based on any form of bartering services.