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Applying for
DeltaCare participation is easy!
You'll receive
a kit from our Network Coordinator containing everything
you need. Here are the items we'll be looking for:
-
A completed
Facility Profile form
-
A signed
and completed Provider Contract and/or Specialty
Amendment Agreement for each dentist in the
practice
-
A completed
W-9 Tax Identification Number form
-
A completed
credential package* for each dentist in the
practice, including:
-
Data
Form
-
Attestation
-
Copy
of Malpractice Declaration page
-
Copy
of New Jersey state license
-
Copy
of DEA certificate, if applicable
-
Copy
of CDS certificate, if applicable
Once all the
information has been received, we will schedule
an appointment for a facility evaluation at your
convenience.
Please note:
It is DeltaCare's policy that all dentists wishing
to participate with DeltaCare be participating
dentists with Delta Dental of New Jersey. If you
are not already a Delta Dental participating dentist,
please let us know and you will also receive a
participation kit with information about joining
the DeltaPremier, DeltaPreferred Option, or Delta's
Advantage Program.
 Click
here to find out more about credentialing
Click
here to view/print CreDentals Provider Data form (PDF
Format)
Click
here to view/print CreDentals Attestation form (PDF
Format)
Click
here to contact our Network Coordinator via e-mail
DeltaCare coverage
is provided by Flagship Dental Plans. This chart
provides only certain highlights of plan coverage.
As with all health plans, there are exclusions
and limitations.
DeltaCare
is underwritten and administered by Flagship
Dental Plans, a wholly-owned subsidiary of
Delta Dental of New Jersey, Inc.
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