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130941Provider Inquiry FormDelta 1213

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The document is a Provider Inquiry Form from Delta Dental, outlining the procedures for resubmitting claims and filing disputes. It specifies that claims can be resubmitted for clerical corrections or additional information, with a review completed in 30 days. Disputes must follow a resubmission attempt and will receive a written response within 45 days. The form requires detailed information about the provider, patient, and nature of the dispute, along with instructions for submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I contact DeltaCare USA?

DeltaCare USAs payer identification number for encounter forms is DDCA3. For more information about electronic encounter form submission, please email our Encounters department.

What is the lawsuit against Delta Dental?

In December 2022, CDA filed legal action against Delta Dental in San Francisco Superior Court. This action was driven by the changes to Delta Dentals reimbursement rate structure and provider agreements that had a significant impact on many members.

How do I appeal a Delta Dental claim?

You can appeal by calling or writing to us within 60 calendar days after you receive the denial, reduction or failure to pay notice. You must follow up a call with a written appeal. We will let you know we got your appeal and give you a summary of the process and timetable for resolving the appeal.

What is the timely filing limit for Delta Dental claim?

When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patients most current eligibility and benefits to determine payment. Generally, claims received more than 12 months after the date of treatment may not be paid.

How do I correct an open dental claim?

Open the claim and change its status to Waiting to Send. Delete the claim. Edit or delete the procedures to use the correct providers. Recreate the claim, then send it.

How do you appeal a dental claim denial?

A proper appeal involves sending the carrier a written request to reconsider the claim. Additional documentation should be included to give the carrier a clearer picture of why you recommended the treatment and why you feel the claim should be reconsidered.

What is a provider inquiry form?

Provider Inquiry Forms may be used for any unique questions concerning claim status; paid or denied claims; and billing concerns. To expedite the handling of written inquiries, we recommend you use a Provider Inquiry Form (Section 2.4. 1).

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