FAQs

How do I register for an online account?

If you already have an online provider account with your Delta Dental member company, you can use your existing login credentials to sign in here.

If you don’t already have an online provider account, you will need to register through your local Delta Dental.

Once you set up your online provider account, you can return to DeltaDentalCoversMe.com to access benefit information for your patients with Individual & Family plan members.
Download instructions for accessing your online account and viewing member plan information

How do I manage my account information?

Contact your local Delta Dental to make changes to your account information.

Find your Delta Dental member company

Where can I access patient benefits information?

You have two options to access patient benefits:

1. The new provider portal has a robust view of patient benefits.
• Search for a patient by name and date of birth or Subscriber ID.
• Further narrow down benefits by searching against specific procedure codes.
• Search treatment history for a tooth number, arch or quadrant (when available).
• Sign in to the provider portal to access these tools.
2. IVR FaxBack will remain available for offices that want to receive benefit information.

Can I submit paper claims?

Delta Dental PPO or Delta Dental Premier providers may submit a claim directly to Delta Dental on behalf of a patient.

To submit a claim, fill out the Dental Plan Claim Form and attach an Attending Dentist Statement.

• Mail the form directly to:
  Delta Dental
  PO Box 103
  Stevens Point, WI 54481-0103
  Electronic Claims Payer ID: WDENC

What could cause an error when submitting claims?

Please refer to the error code received when submitting the claim electronically. Some of the most common reasons for claim rejection include:

“Invalid Subscriber” means the policy was not found with the information provided.

• Make sure the claim is submitted to the correct insurance company. Claims for members with Individual & Family plans we service go to the address listed above.
• Make sure the claim includes a valid 11-digit subscriber ID number for the dental plan (not a Social Security number).
• Make sure the subscriber and patient information (first name, last name, date of birth) match the way they appear in Provider Portal when accessing patient benefits or on the IVR FaxBack

“Provider Match Not Found” means the provider information doesn’t match what is listed with your local Delta Dental in the dentist directory.

• Make sure the treating dentist name is listed in first name, last name format (not “signature on file”)
• Make sure the dentist’s valid NPI1 and Tax ID are listed on the claim.
• Make sure the billing and treating address are listed on the claim the same way they appear in the Delta Dental dentist directory.

“Invalid Procedure” or “Too Many Teeth” means something with the procedures listed on the claim can’t be validated.

• Make sure each procedure code listed is a valid CDT Code for the date of service. The CDT Code manual is updated each year. Outdated/invalid codes cannot be processed.
• Make sure each procedure has a submitted fee. $0 claims cannot be processed.
• If a claim has orthodontic treatment (D7282, D7283, D8080, D8703, etc.), make sure to complete the section of the claim asking “Is Treatment For Orthodontics” as yes with the required information.
• Make sure tooth numbers are included only for procedure codes that are tooth-specific. For example, fillings are tooth-specific and should include both the tooth number and surfaces, denture codes are specific to the arch, so no tooth numbers should be listed.

How do you submit documentation after receiving a request for additional information to process a claim for reference codes: 85, 185, 285, 385?

If additional information is needed to process a claim, please do not send a new claim. This will cause the claim to process as a duplicate service, and it will be automatically denied. The correct way to submit this documentation would be to return the original Explanation of Payments and include all the necessary information for it to be added to the original claim, where it will be reviewed and processed.

This can be submitted by mail to:

Delta Dental
PO Box 103
Stevens Point, WI 54481

What results will the procedure code lookup tool return?

The tool will display benefit information for the selected member as of the date it is used. To see benefits for other members on the policy click "Return to Search", click "Submit", and select the desired member from the list given. 

How we build our networks

Delta Dental builds and maintains its provider networks by ensuring dentists are licensed, insured, and compliant with all laws and regulations. Further, providers must complete all Delta Dental credentialing requirements and comply with Delta Dental participation agreements, rules, and regulations. Factors like geographic location, member referrals, provider requests, and group input are also considered. Periodic recruitment efforts help expand and sustain the network to meet member needs.