Pre-treatment Estimates

Use Provider Tools to avoid surprises with a free, real-time pre-treatment estimate (coming soon for DeltaCare® USA).

Before you start treatment, use the “Submit Claim” or “My Patients” tool to request a pre-treatment estimate. Pre-treatment estimates often process within moments (when clinical review isn’t required), so you can talk with your patients about treatment plans while they are still in your office. Pre-treatment estimates tell you about:

  • Contractual limitations or exclusions that apply to your treatment plan
  • Delta Dental’s estimated payment amount
  • The patient’s estimated payment portion

Advantages

  • Helps you to determine how best to plan treatment; for example, treatment may be done in segments, over weeks, months or years, to incorporate all available benefits
  • Enables you to develop a payment plan for the patient, taking into account what Delta Dental is expected to pay
  • Receive e-mail notifications when new documents are available to review online- (when you sign up for to discontinue paper documents).

When to Request a Pre-treatment Estimate

  • Expensive or extensive treatment is being considered
  • Dental plan annual maximum, limitations and/or exclusions may affect coverage

How to Request a Pre-treatment Estimate

Log in (or register) for Online Services.

  • From the Provider Tools screen, use the “My Patients” tool or “Submit Claim” tool for free real-time, pre-populated, pre-treatment estimates.
  • You’ll see Delta Dental’s estimated payment and the patient’s portion often within moments (when clinical review is not necessary).

Or, you may mail a paper claim to Delta Dental. Include all required x-rays, documentation and/or written narratives. You will receive by mail a pre-treatment estimate showing the amount Delta Dental is estimated to pay and the amount of the patient’s responsibility. Unfortunately, we cannot provide pre-treatment estimates over the telephone.

Limitations

Keep in mind, the pre-treatment estimate is not a guarantee of payment and it does not check the patient’s:

  • Eligibility (until the date of service)
  • Incentive levels
  • Maximum or deductible
  • Any additional coverage that may apply

If you need this information, please log in to Online Services (or register if you have not already done so) to check eligibility and benefits online.

When the services are complete and a claim is received for payment, Delta Dental will calculate its payment based on the enrollee’s current eligibility, amount remaining in his/her annual maximum and any deductible requirements.

How to Submit Claim for Payment

When the services are completed, log in to Online Services and use the “My Patients” tool or the “Submit Claim” tool to transmit a new free, real-time claim for payment.

Or, transmit a claim via a clearinghouse, or complete and mail a paper claim to the Delta Dental company through which the patient has coverage.

  • Include on the claim only the services that were provided (omit services that weren’t provided, even if they were part of the original pre-treatment estimate)
  • Include any additional services that were provided
  • Submit the claim to Delta Dental as soon as possible after the services are completed (in all cases, submit claims not more than six months after the date of service)

We will process the new claim for payment using the current eligibility and benefits provisions.

Online Services

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