Billing and claims
Find everything you need to manage your billing and claims with us
Electronic remittance explanation codes
Access our electronic remittance explanation codes for details about Claims Adjustment reason codes
How to file claims electronically
Save your office time and money — file claims electronically.
If you do not already have an account with one of the dental claims provider clearinghouses we work with, we encourage you to set one up.
Clearinghouses we work with
Emdeon (formerly WebMD)
220 Burnham St.
South Windsor, CT 06074
888-255-7293
Payor ID = CDOR1
APEXEDI Inc.
174 S. 1000 East
American Folk, UT 84003
801-642-0285
Payor ID = CDOR1
EDI Health Group Inc. – DentalXchange (EHG)
17701 Cowan St., Suite 250
Irvine, CA 92614
949-852-0825
TESIA Clearinghouse, LLC
1540 W. Edgewood Ave.
Indianapolis, IN 46217
800-724-7240
Practice management systems that submit directly to Delta Dental
Astra Practice Partners
10505 SE 17th Ave.Milwaukie, OR 97222
503-243-3966
Quality Systems Inc.
18111 Von Karman #600Irvine, CA 92612
949-255-2600
Direct connection to Delta Dental
We also support direct connections between offices and Delta Dental. Transaction standard is the 837 Dental Claim required by HIPAA Administrative Simplification.
Support for claims from other Delta Dental providers
For help with claims from other Delta Dental providers, please contact the provider directly.
Predeterminations
Predeterminations are optional. You may choose to get one for extensive treatment. To request one, you will need to partially complete the form and submit it electronically.
Please also:
- Check the block for “Dentist's pre-treatment estimate”
- Use ADA codes for all procedures
- Do not show appointment dates
- Do not include a dentist’s signature
- Include any clinical information that may be helpful in determining benefits
- Do not submit X-rays, unless requested by our dental consultant. Special handling is required for X-rays, which will slow the claims process.
- Use correct ID numbers: subscriber ID number for commercial and recipient ID number for Oregon Health Plan (for Oregon providers)
- Watch for correct patient-to-subscriber relationship
Tips for reducing claims processing time
- Submit claims electronically. We process electronic claims first each day. See below for a list of electronic claims processing providers.
- For paper claims, please use the standard ADA form, either typed or legibly printed
- Verify the patient's relationship to the subscriber. Make sure plan information is correct before submitting claims.
- Include all pertinent information: subscriber ID or recipient ID (if Oregon Health Plan), patient name and date of birth, tooth number(s) or quadrant, and current ADA codes. Your office can call the ADA at 800-947-4746 to order the most current CDT codebook.
- Please do not send X-rays unless we request them. In some cases, we need clinical information to determine benefits.
- If a patient is covered by more than one Delta Dental program, submit one claim form and include the name of the subscriber, subscriber ID number, employer (if applicable) and the Delta Dental group number for both plans. If the patient is covered by another carrier, please indicate the above information plus the name, address and policy number of the other carrier. If a patient has primary insurance through a carrier other than Delta Dental, the EOB of primary payment amount from the other insurance company will need to accompany the claim for consideration of payment.
Please contact us before submitting duplicate claims:
- Check Benefit Tracker to see the status of a claim. If you haven't registered for this free online service, register now.
- If you receive an explanation of payment (EOP) showing that your claim has already been processed before you receive a check, this indicates that your rebill was unnecessary. The claim was processed and is pending for the next scheduled payment date.
- Rebilling without contacting us slows our turnaround time and delays payment
- Use miscellaneous codes appropriately with clinical information
- Code "R6, 9A6, 9A8" on the EOP are for charges exceeding the amount allowed. This is a provider discount and should not be billed to the patient.
PLEASE NOTE: Do not use a highlighter on paper claims.