Avoid Late Claim Submission
When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patient’s most current eligibility and benefits to determine payment.
Generally, claims received more than 12 months after the date of treatment may not be paid. However, some programs may require you to submit claims within a shorter period of time (e.g., 90 days for Texas CHIP program). To be sure, please refer to your dentist handbook. If you receive notification that no payment was made because of late submission:
- The patient is responsible for his or her coinsurance/copayment portion only. The amount that would have been payable by Delta Dental may not be charged to the patient.
- If late submission occurred because of extenuating circumstances (for example, the patient did not advise you sooner of the existence of coverage), you may request reevaluation of the decision to disallow payment. Please call or write to our Contact Center (and be sure to include all relevant information).