Claims submitted to Delta Dental of New Jersey must conspicuously disclose a dentist’s intent to waive a patient’s copayment responsibility. This intention must be noted on the face of each paper claim form or in the notes/remarks section of an electronic claim.
If the intention to waive all or a portion of the patient’s copayment responsibility is not disclosed on the claim form, the dentist’s actual fee, as reported on the claim, will be inaccurate.
The submission of a claim to Delta Dental (or to any insurance company) that contains a fee higher than what is actually charged or billed to, and intended to be collected from, the patient is not permissible. It overstates the dentist’s actual fee and will result in an overpayment that must be returned to Delta Dental.
For more information on this topic, please refer to:
- New Jersey Board of Dentistry, Administrative Code, N.J.A.C. 13:30-8.10(c)
- Connecticut General Statutes, Title 20, Chapter 379, Section 20-114
- Delta Dental of New Jersey Participation Agreement
- Delta Dental of New Jersey Dentist Handbook for Participating Dentists, Chapter 4, Form Completion and Chapter 11, Claim Verifications
To report any suspected fraud to Delta Dental of New Jersey:
- Call our fraud hotline: (888) 696-3262
- Email: reportfraud@deltadentalnj.com
- Fax: (973) 944-4573
Write to:
Delta Dental of New Jersey
Special Investigations Unit
1639 Route 10
Parsippany, NJ 07054
