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Delta Dental patient eligibility and benefits

Patient eligibility and benefits

Learn how to check your patient's eligibility and benefits online, via telephone or by fax. 

Patient eligibility and benefits

Everything you need to know about verifying patient benefits and eligibility online, via telephone or by fax. 

Be sure to verify patient eligibility before providing services to make sure you’ll receive the appropriate compensation. Use Provider Tools for up-to-date, unlimited eligibility and benefits information, including remaining maximums and deductibles. 

Steps to verify eligibility:

  1. Log in and select Eligibility & Benefits. Enter the patient’s name and select Existing or New.
    • For new patients: Enter the first and last name and date of birth. Then, select "Find Patient" for eligibility status and benefit details.
    • For existing patients: You'll see the Eligibility & Benefits Summary first, followed by benefit and covered services, maximum and deductible amounts. Finally, you can find "other provisions" details for missing tooth clause, COB rules and more at the end of the page. 
  2. Link to more details. Use the links in the sidebar to quickly access:
    • Benefit Details: get benefit levels for procedures by category, such as Preventive, Restorative, Endodontics, etc.
    • Benefit Search — enter up to 10 procedure codes, a keyword or a tooth number for more specific information.
    • Treatment History — review benefit limitations and dates of service from claims we’ve paid from any dentist.
  3. Or use another great tool: My Patients. This tool lists your existing patients and their eligibility status. Select under Actions at the end of a row to open that patient’s Eligibility & Benefits Summary. Eligibility and benefits information is also available by using our automated telephone service. 

Our automated voice response telephone service is a convenient way to obtain eligibility and benefits information and more for your Delta Dental PPO™, Delta Dental Premier® and DeltaCare® USA patients. 

Some tips for using the service:

  • Use the service during business hours, as well as extended hours during the week and on weekends.
  • Before you call, have all of the following items ready:
    • Your tax ID number (TIN) that is on file with Delta Dental
    • The subscriber's ID number and date of birth and the patient's date of birth (the ID may be the subscriber's social security number or another number, such as an employee ID or alternate ID assigned by the subscriber's employer)
    • Your fax number, if you will be requesting a faxed summary
  • Return to the main menu any time by pressing "9".
  • Move quickly through the system. As soon as you know your response choice to the automated question, you may say or enter it. You don't need to wait until all options are offered.
  • Say "claim status" for the amount Delta Dental paid on a specific claim.
  • Say "claim details" for the amount Delta Dental paid per procedure.
  • To hear the benefit summary, stay on the line after eligibility is played, or just press pound (#).

Fast Fax is an eligibility and benefits summary that is faxed to your office. Follow the steps on  this PDF to use the automated telephone service and obtain Fast Fax.