Specialty Referrals, Preauthorization, and Payments

DeltaCare has recently modified the specialty referral process in an effort to simplify the administration of the DeltaCare program. For most endodontic, oral surgery services, and orthodontic services, eligible DeltaCare enrollees may be referred directly from the patient's general dentist to participating DeltaCare specialists. The patient should present to your office with the proper diagnostic materials along with a DeltaCare specialty referral form.

For treatments such as primary care services which are complicated, surgical or serial extractions and complicated treatment plans, a preauthorization must be obtained either by submitting a mail-in preauthorization form or through an emergency authorization number by the patient's primary care general dentist.

Please note:

• For specialty payment of treatment rendered: The dentist rendering care must date and sign the specialty form and submit it to DeltaCare along with any diagnostic x-rays required.

• For preauthorization of treatment plans: Complete the specialty form and forward it to DeltaCare with the proper diagnostic materials.

• Orthodontic referrals should have an authorization number on the form to confirm that the patient's group contract does include orthodontic benefits.

When the general dentist performs specialty services, please ensure that the proper diagnostics are submitted when requesting payment.

• Click here to view/print Specialty Referral forms
• Click here to contact our Network Coordinator via e-mail
  
  

DeltaCare is underwritten and administered by Flagship Dental Plans, a wholly-owned subsidiary of Delta Dental of New Jersey, Inc.