Just the FAQs
Answers to commonly asked questions
Request a network participation packet or email:
PR-DCUSA-West@delta.org (for AK, AR, AZ, CA, CO, HI, IA, ID, KS, LA, MO, MT, ND, NE, NM, NV, OK, OR, SD, TX, UT, WA, WY).
PR-DCUSA-East@delta.org (for AL, CT, DC, DE, FL, GA, IL, IN, KY, MA, MD, ME, MI, MN, MS, NC, NH, NJ, NY, OH, PA, RI, SC, TN, VA, VT, WI, WV)
Delta Dental focuses on getting patients into your office as an essential part of achieving and maintaining good oral health.
Other advantages include:
Yes, by signing a Delta Dental Participating Provider Agreement with your local Delta Dental, your participation is honored throughout the national Delta Dental system.
Please keep in mind that patient claims must be submitted to the appropriate Delta Dental company for processing. You can determine eligibility for all Delta Dental enrollees by logging in to Provider Tools.
Generally, your access will expire in 30 minutes. You’ll receive a warning message two minutes before this occurs, asking you to click on “OK” to continue. If your session expires, you’ll be redirected to Provider Tools to log in again.
Yes, by using the Eligibility & Benefits tool. First, verify the patient’s eligibility. Then, select the option to add the patient. You can submit a real-time claim or pre-treatment estimate for patients using the link in the My Patients tool.
The patient will be displayed twice, with primary coverage first (when both coverages are within our group of Delta Dental companies).
Provider Tools works best with current versions of Internet Explorer, Chrome, Firefox and Safari. (Be sure to keep your browser updated.)
Any person authorized by the dentist may register. We encourage each person to register separately so that if someone leaves the practice, that person’s username and password can be deleted while leaving the others intact and usable.
Enter the following information, which must match our records exactly:
• The dentist’s first and last names
• The dentist’s tax identification number (TIN), without hyphens or spaces
• The practice’s five-digit ZIP code
• The dentist’s license number (letters or preceding zeros are usually not included). In addition, your National Provider Identifier (NPI) must be registered with us.
On average, claims that are adjudicated automatically will be processed in less than three business days from the date the claim is received. However, claims that require reviews by a claim examiner or dental consultant, as well as adjusted claims, may take longer.
Submitting a monthly claim for orthodontics is not necessary. Normally, the claim is filed for the entire treatment, and Delta Dental automatically makes a payment each month until the treatment is completed, terminated or the patient is no longer eligible. Contact the patient's Delta Dental with payment questions.
You will not see this type of adjustment in the payments list, but you will find it on your claim statement using the My Claim Documents tool.
Direct deposit (EFT) is available to any dentist who receives payments from our group of Delta Dental companies. ERA (Electronic Remittance Advice) is available if you use a clearinghouse to submit claims. To see the list of clearinghouses we work with, review the ERA page.
Up to five attachments per claim or pre-treatment estimate. The total size limit for all attachments combined is 5 MB. The file types that may be attached are PDF, JPG, GIF and TIF.
Apply online at the National Plan & Provider Enumeration System (NPPES) website: nppes.cms.hhs.gov. When you receive a confirmation from the NPPES containing your NPI (National Provider Identifier), please email it to us at email@example.com. (It is not enough to simply use your NPI on claims — we must be notified separately.)
For x-rays and some other procedures, you’ll need to include specific documentation when you submit the claim. Find a list of procedures that require additional documentation on the Claims and payments page. Be sure to follow all requirements for submitting the documentation.