Proper Submission of Dental Claim Forms
- Report every date that a dental service was actually performed or completed.
- Multi-staged procedures such as crowns, bridges, dentures, and root canal treatment should be submitted upon completion of the service.
- Completion date for fixed partial dentures, crowns, onlays, and inlays is the cementation date regardless of the type of cement utilized.
- Completion date is the date of insertion for removable prosthetic appliances.
- Completion date for immediate dentures is the date the remaining teeth are removed and the denture is inserted.
- Completion date for root canal therapy is the date the canals are permanently filled.
- Report each dental service or procedure that was rendered, including— but not limited to— tooth number, surfaces and materials.
Coordination of benefits
- Report any other benefit coverage, insurance payments, and adjustments for the dental services.
Disclosure of waiver
- Insure you clearly disclose on the claim form if there is any intention to waive a patient's co-payment, or any portion of the patient’s co-payment responsibility.
Disclosure of discounts
- Insure any discounts extended to the patient for these services are clearly detailed, including any reduced fees that resulted from the use of coupons or promotions.
Disclosure of "free" services
- Clearly reflect the fee of the services actually being charged and collected from the patient.
Services not performed
- Report only services that are actually performed.
Identification of appropriate dentist
- Insure both the billing dentist and the treating dentist are clearly identified by name and license number.
- Delta Dental does not make payment based on any form of bartering services.