Claim Completion Instructions

The following are tips for submitting claims to Delta Dental.

• Thoroughly complete the claim with clear and legible information.
• Do not use patients' nicknames.
• Document exceptional or unusual circumstances in the comments/notes field of an electronic claim or any available space on a paper claim.
• X-rays are required for a few services only; don't submit x-rays unnecessarily.
• Send x-ray copies only.

For paper claims:

• Use any standard dental claim form, such as an ADA form, which is available for purchase from many dental office supply companies.
• Or, you may download and print a claim form from our Web site.

Dependents Age 19 and Over

For full time students, enter the name of the school and the city in which it is located on the claim. If the patient is a dependent with a disability, enter the nature of the disability.

Tax Identification Number (TIN)

Enter the TIN of the billing dentist or dental entity. Inform our Dentist Network Administration and Contracting department if your TIN or the name associated with that TIN changes.

National Provider Identifier (NPI)

Use new claim forms that accommodate the NPI by providing a specific space for it. (This might require you to upgrade your software.) Enter the NPI of the billing dentist or dental entity, as well as the treating dentist's NPI (if they are different).

Electronic Encounter Forms for DeltaCare^® USA

You can save time and money while helping the environment by eliminating the use of paper encounter forms and electronically submitting your encounter forms to DeltaCare USA.

Some of the benefits of streamlining your office's processes by using electronic encounter forms include:

• Saving money by eliminating printing, copying and mailing encounter forms.
• Saving time by submitting electronic encounter forms daily, which can eliminate the need to spend more time running monthly reports.
• Receiving prompt notification of any invalid data, allowing you to make the necessary corrections and re-submit right away.
• Receiving reports of all successfully transmitted encounter forms, reducing follow-up on unpaid submissions.

DeltaCare USA's payer identification number for encounter forms is DDCA3.

For more information about electronic encounter form submission, please contact our Encounters department via e-mail at encounters-cerritos@delta.org or by telephone at 800-801-7105.