Report suspicious activity

We are committed to protecting your information and protecting you against insurance fraud. Use this form to report suspicious activity. Please provide as much information as possible to ensure we can investigate the case. You do not need to provide your contact information. However, providing it can help us seek additional, relevant information in order to take action.

All fields are required unless marked optional

Reporting on

Dental office Subscriber Employee

Subscriber information

Who are you reporting on?

Full name (required)

Member ID (required)

Address (required)

City (required)

State (required)

ZIP (required)

Phone (required)

Claim information

Claim number (required)

Group number (required)

Transaction date (required)

Paid date (required)

Report details

Description of issues (required)

Reporter information

Contact information is not required but can help Delta Dental avoid the inability to take action on any report.

Who are you?

Full name

Optional

Phone or email

Optional

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