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Delta Dental Premier
Delta Dental Premier is the traditional fee-for-service plan with comprehensive and flexible dental benefit packages. Members may choose to go to any licensed dentist, but receive the highest benefit by seeing a Delta Dental Premier dentist. To apply for Delta Dental Premier participation, please complete the following:
- Participating Dentist Agreement Summary Disclosure Form click here
- Delta Dental Premier Participating Dentist Agreement (completed and signed) click here
- Substitute Form W-9 (completed and signed) click here
- Provider Credentialing Form (completed and signed) click here
- Also submit legible copies of the following:
- Colorado Dental License
- Dental Diploma
- D.E.A. Registration
- Current Malpractice Insurance Declaration Page
- Basic Life Support Certification
- Specialty Certification, if applicable
- National Provider Identifier (NPI) Official Notification
For reimbursement information regarding Two-Way Pricing and Delta Dental's Maximum Plan Allowance (MPA) click here
Participation in the Delta Dental Premier network is required for participation in any other Delta Dental network and/or program.
Delta Dental PPO
Members may choose any licensed dentist for treatment under the Delta Dental PPO plan, but they receive their highest level of benefits if they choose a Delta Dental PPO dentist. PPO dentists have agreed to accept the PPO Schedule of Allowances as payment in full for services.
To apply for Delta Dental PPO participation, submit all of the documents required for Delta Dental Premier participation plus the Delta Dental PPO Participating Dentist Agreement.
Currently a Delta Dental Premier provider? Delta Dental Premier dentists who want to join the PPO program must submit a completed Delta Dental PPO Participating Dentist Agreement, along with updated copies of the additional documents listed below:
- Participating Dentist Agreement Summary Disclosure Form click here
- Delta Dental PPO Participating Dentist Agreement (completed and signed) click here
- Substitute Form W-9 (completed and signed) click here
- Provider Credentialing Form (completed and signed) click here
- Also submit legible copies of the following:
- D.E.A. Registration
- Current Malpractice Insurance Declaration Page
- Basic Life Support Certification
- Specialty Certification, if applicable
- National Provider Identifier (NPI) Official Notification, if NPI has been obtained
For the Delta Dental PPO Schedule of Allowances  Log on here
Agreements for Additional Delta Dental of Colorado Programs
Participation in the Delta Dental Premier network is required for participation in any additional Delta Dental of Colorado programs.
Child Health Plan Plus (CHP+)
- CHP+ Premier Agreement (completed and signed) Log on here
This Agreement is required if you choose to provide treatment to children in the CHP+ program, but you do not participate in the Delta Dental PPO network for any other program.
Delta Dental Patient Direct
Delta Dental Patient Direct is a dental discount plan offered to individuals and families. The plan offers an average of 30% savings on covered dental procedures.
- Delta Dental Patient Direct Participating Dentist Agreement (completed and signed) click here
This Agreement is required if you choose to provide services to individuals who have enrolled in the Delta Dental Patient Direct discount program. As a Delta Dental Patient Direct participating provider, you agree to accept the fees listed in the Delta Dental Patient Direct Schedule of Allowances as payment in full for procedures performed. All fees are collected directly from the member. No claims are submitted to Delta Dental of Colorado, and you receive no payment from Delta Dental of Colorado.
- For the Delta Dental Patient Direct Schedule of Allowances Log on here
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