Who is eligible to apply to become a Delta Dental participating dentist?
Any licensed dentist in the United States is eligible to apply to join a Delta Dental network. [Return]
Is a signed agreement a requirement to be part of the Delta Dental networks?
Yes, a signed network agreement is required to become a network provider. [Return]
Does Delta Dental require credentialing?
As part of our commitment to quality, Delta Dental requires credentialing upon enrollment and every three years thereafter. [Return]
I’m interested in becoming a participating provider. How do I contact Delta Dental?
To learn more about becoming an in-network provider, call our provider relations team 1-800-328-1188. [Return]
How should I submit procedures that are being done for cosmetic purposes?
Cosmetic procedures are typically not considered covered services and should not be submitted.
If a patient requests that you submit a cosmetic procedure, contact our provider team at 1-800-328-1188 for steps on how to submit the claim for review.
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Where can I find claims history for my patients?
Information on claims history is available in the Dental Office Toolkit (DOT). Visit our “Dental Office Toolkit resources” page to learn more. [Return]
Where can I find the date a patient is eligible for benefits for a procedure?
Benefit details and eligibility information are available in the Dental Office Toolkit (DOT). Visit our “Dental Office Toolkit resources” page to learn more. [Return]
Where is the claims processing address displayed on the website?
For Delta Dental of Nebraska members, claims processing information can be found on our Contact us page.
For Delta Dental members with coverage through another Delta Dental plan, additional information can be found on DeltaDental.com. [Return]
Where can I find waiting period information for patients' coverage?
Waiting period information is available in the Dental Office Toolkit (DOT). Visit our “Dental Office Toolkit resources” page to learn more. [Return]
What is an 835/Electronic Remittance Advice (ERA)?
The 835/ERA is an electronic version of the provider Explanation of Benefits (EOB). [Return]
How will I receive an 835/Electronic Remittance Advice (ERA)?
If your office submits claims via electronic clearinghouse, you will receive your 835/ERA directly from your electronic clearinghouse.
If your office uses direct deposit, you’ll receive 835/ERA in DOT.
Otherwise, you’ll receive a paper remittance advice in the mail. [Return]
How will the 835/Electronic Remittance be loaded into my Practice Management System?
Check with your software vendor to see what capabilities they offer. Some software vendors have the capability of automatically posting this data directly into your accounts receivable. Others may only provide a display image that can be printed and would need to be manually entered. [Return]
Will I be charged for the 835/Electronic Remittance Advice (ERA)?
Delta Dental does not charge a fee for the 835/ERA. Check with your clearinghouse and software vendor to determine what, if any, cost there may be for you. [Return]
Where can I find additional information on the 835/Electronic Remittance Advice (ERA)?
The 835/ERA will reflect a more general version of our processing policies. Greater details and additional information can be found in the Dental Office Toolkit (DOT). Visit, our “Dental Office Toolkit resources” page to learn more.. [Return]
Can I still receive a printed Explanation of Benefits (EOB) from Delta Dental?
Paper EOBs are mailed to all providers who have not registered for direct deposit. Once a provider is enrolled in direct deposit, EOBs are only available via DOT or through an electronic clearinghouse. [Return]
What is the National Provider Identifier (NPI)?
The National Provider Identifier (NPI) is part of the Health Insurance Portability and Accountability Act (HIPAA). The NPI regulation establishes one unique identifying number for each health care provider.
Additional information can be found on the NPI Registry website. [Return]
What are the advantages of the National Provider Identifier (NPI)?
The NPI provides a single unique provider identifier for all health plans to utilize and track transactions to avoid duplication. [Return]
Who is required to apply for a National Provider Identifier (NPI)?
All individuals and organizations who meet the definition of health care provider as described at 45 CFR 160.103 are eligible to obtain a National Provider Identifier, or NPI. If you are a HIPAA covered provider or if you are a health care provider/supplier who bills Medicare for your services, you need an NPI.
How is my National Provider Identifier (NPI) determined?
The NPI is a random ten-digit number. It never expires. It contains no inherent information about the provider, such as state of residence or license number. NPI numbers are administered by the Centers for Medicare and Medicaid Services (CMS), which has contracted with the National Plan and Provider Enumeration System (NPPES).
Additional information can be found on the NPI Registry website.
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How do I use National Provider Identifier (NPI) type 1 and type 2 when submitting claims?
Type 1: Individuals (such as dentists, advanced dental therapists and dental therapists) – No two individuals can have the same NPI and no individual person can have more than one type 1 NPI. The NPI for type 1 should be placed in box 54 on the American Dental Association (ADA) claim form.
Type 2 (Entity) NPI – This type of NPI is registered to a business entity, either a service office or a company (TIN) OR a sole practitioner that has a legal entity name (States may vary: PC, PLC, PLLC, Inc., Incorporated, PA, LLC, LTD, etc.). These practices are considered a Corporation and must acquire an NPI Type 2 and file claims according to Group Practice Guidelines.The NPI for type 2 should be placed in box 49 on the ADA claim form.
Please note: CMS regulations indicate that all corporations must obtain and use a type 2 (Organization/Billing) NPI number on Medicaid and Medicare Advantage claims. The type 2 NPI number should be listed in the designated field on the ADA claim form, in addition to the treating provider’s type 1 NPI.
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How do I apply for a National Provider Identifier (NPI)?
You can apply for a NPI on the NPI Registry website. [Return]
What do I do with a National Provider Identifier (NPI) once I have it?
Once you have your NPI, update your clinic record with Delta Dental's provider team: [email protected] or 800-328-1188.
Once the clinic record has been updated, use the NPI on all claim submissions. [Return]
Where can I go for additional help and information regarding a National Provider Identifier (NPI) number?
Additional information can be found on the NPI Registry website. [Return]
What are the CDT codes associated with teledentistry?
The codes for teledentistry are D9995 and D9996. These codes are considered inclusive in patient management and are not billable to the patient.
Please note: D9995 and D9996 must be submitted along with another code for example, D0140. The fee for D0140 will be processed based on the member’s benefits. [Return]
