Help Center: Dentists

Claims

Does Delta Dental of Colorado accept electronic claims?

Yes, we accept electronic claims from a variety of clearinghouses, including DentalXChange, Change Healthcare, and Tesia. Our Payer ID# is 84056. Delta Dental Premier® and Delta Dental PPO™ participating providers can also submit claims online by logging into our secure dentist page.

What if I use a clearinghouse not included in your list of accepted clearinghouses?

Delta Dental of Colorado can accept claims from a variety of clearinghouses, including DentalXChange, Change Healthcare and Tesia. If you use a different clearinghouse than what is listed here, contact our customer service team to see if we can accept claims from your current clearinghouse. You may also submit claims online in real-time by logging in as a provider, or you can print them to paper and mail or fax them to us at:

Delta Dental of Colorado
Attn: Claims Department 
PO Box 173803
Denver, CO 80217-3803

Fax: 303-741-2116

How do I submit claims to Delta Dental?

We can accept your claims electronically, by fax, or by mail. To submit claims electronically submit through your Practice Management System or log in to our secure provider portal. Claims can also be mailed or faxed to:

Delta Dental of Colorado
Attn: Claims Department 
PO Box 173803
Denver, CO 80217-3803

Fax: 303-741-2116

What should be included on claim forms to Delta Dental?

Be sure to include the following on all claim forms:

•    Subscriber's name, address, date of birth and identification number
•    Patient's name and date of birth
•    Patient’s relationship to subscriber
•    The dentist's complete license number
•    The dentist’s EIN (TIN or SSN)
•    National Provider Identifier (NPI)
•    Narratives, X-Rays and intra-oral photos (please refer to your provider manual for procedures requiring this documentation)
•    Dates of service (completion or delivery dates) for multiple visit services
•    Tooth numbers or quadrants and indicate tooth surfaces where applicable
•    Complete dual coverage information, including the subscriber's identification number and date of birth, and attach the primary carrier's statement (if applicable).
 

Should I also send a paper claim to Delta Dental if I have sent one electronically?

To ensure quick processing, please do not submit paper claims in addition to electronic claims. You can check the status of your submitted claims quickly and easily by logging in to our secure provider portal.

How do I check the status of a claim?

You can check the status of your claims 24/7 through our secure provider portal. Simply log in and a list of your recent in-process claims will appear, or you can search all claims by clicking on the Claims and/or Payments tabs. You can also check claim status through our Interactive Voice Response System (IVR) by dialing 1-800-610-0201 and pressing 1 for claim status. Please do not send in duplicate claims if the claim is showing in our system, as it will delay the process.

Does Delta Dental of Colorado accept electronic attachments?

Yes, we accept electronic attachments through National Electronic Attachments (NEA). Please note, the NEA attachment number must be referenced on the claim in the narrative section. If you receive a Denial for Information (DFI) from Delta Dental, you may submit an electronic attachment without a claim if you submit the claim number with the attachment. Please do not send an electronic attachment without a claim or without reference to a Delta Dental claim number.

How do I find out more about filing electronic attachments from my office?

In order to submit electronic attachments, you will need equipment that produces an electronic copy of a document or image. The type of equipment and other requirements depends on which vendor you choose to support this capability. Check with your practice management software vendor for more details. You can also contact National Electronic Attachments (NEA) for more information.

What procedures require radiographs, narratives, and/or periocharting?

Please reference the Codes Requiring Attachments document for detail on which procedures require radiographs, narratives, and/or periocharting.

What procedures require narratives?

The following procedures require narratives to be submitted with the claim:

•    Implants - Indicating medical necessity
•    Any procedure code ending in 99 – Miscellaneous codes
•    Any CDT procedure code that has 'by report' in the descriptor
•    Other procedures that are unclear or require dental necessity rationale

What procedures require periodontal charting?

The following periodontal procedures require periodontal charting:
CDT Codes 4210; 4211; 4230; 4231; 4240; 4241; 4245; 4260; 4261; 4263; 4264; 4266; 4267; 4270; 4273; 4275; 4276; 4277; 4278; 4341; and 4342.

What is the correct date of service for multiple visit procedures (root canals, crowns, fixed and removable prosthetics)?

The correct date of service is the final fill date, the cementation date and/or the delivery date. Delta Dental will only pay for completed dental services.

Participation

If I participate with Delta Dental of Colorado, do I participate with all other Delta Dental member companies?

Yes. By signing a Delta Dental of Colorado Participating Provider Agreement, your participation is honored throughout the national Delta Dental system. Please keep in mind that if your patient is covered under a Delta Dental National Coverage plan, claims must be submitted to the appropriate Delta Dental member company for processing. You are still guaranteed direct payment and Colorado Maximum Plan Allowances (MPA) for these claims.

What is the difference between Delta Dental Premier and Delta Dental PPO?

Delta Dental Premier® is the largest dental network in Colorado and across the nation. This traditional fee-for-service program guarantees participating providers direct reimbursement based on the lesser of their submitted fee or Delta Dental of Colorado's Maximum Plan Allowance (MPA). Subscribers with Delta Dental Premier plans usually experience lower out-of-pocket costs when visiting a Delta Dental Premier participating provider than when visiting a nonparticipating provider.

Delta Dental PPO™ is our preferred provider network. This discounted fee program guarantees participating providers direct reimbursement based on the lesser of their submitted fee or the Delta Dental PPO fee schedule. Employers actively encourage their employees to select Delta Dental's PPO network dentists because their out-of-pocket expenses may be lower and PPO is the top pick by employees.

Note: Please make sure to check your patient’s benefit plan to ensure that you participate in the Delta Dental network covered by their plan. Get more information on our plans and networks.

What are the advantages of participating with Delta Dental Premier?

Delta Dental Premier® participating providers are guaranteed direct payment for services rendered to Delta Dental Premier patients. This will save you a significant amount of time, as well as reduce your billing costs. Your name is also published as a participating Delta Dental Premier provider in directories sent to our groups, as well as on our website. Delta Dental Premier subscribers generally have higher out-of-pocket expenses when they visit Delta Dental Premier participating providers.

What reimbursement will I receive as a Delta Dental Premier participating provider?

Delta Dental of Colorado's reimbursement is based on the Maximum Plan Allowance (MPA) concept. Our MPAs are based on geographical regions and specialty training. The fee schedules are found on the Documents tab when you're logged in to the provider portal.

What are the advantages of participating with Delta Dental PPO?

Delta Dental PPO™ providers enjoy all the advantages of a Delta Dental Premier provider. Additionally, PPO plans are the most common plan chosen by employer groups and their employees are encouraged to seek care from Delta Dental PPO providers because, when they do, their out-of-pocket costs are usually lower. Employers and employees alike are becoming savvier than ever, resulting in more patients choosing PPO.

What reimbursement will I receive as a Delta Dental PPO participating provider?

Delta Dental of Colorado's PPO reimbursement is based on a published fee schedule. Fees are based on geographical regions and specialty training. The fee schedules are found on the Documents tab when you're logged in to the provider portal.

How do I become a Delta Dental participating provider?

To become a Delta Dental participating provider, please visit the Join Our Network provider page.

How can I view the PPO fee schedule for my region?

Please log in to the provider portal and select the Documents tab. The applicable fee schedules are available for your convenience. If you need assistance, contact provider relations at profservices677@ddpco.com or 303-889-8677.

If I am a participating Delta Dental provider, do I also participate with the TRICARE Retiree Program?

DeltaSelect TRICARE Retiree Dental Program is now considered a Delta Dental PPO™ program. This means all participating Delta Dental dentists will receive direct payment according to Delta Dental of Colorado allowances. For those dentists that are participating with the Delta Dental PPO program, you are considered in-network for TRICARE Retiree Dental Program patients. Premier providers can join the Legion network to be eligible to treat TRICARE patients.

How do I determine patients' benefits and eligibility?

You can access your patients’ benefits quickly and easily by logging into our secure provider portal, where you can check benefits and eligibility, claims status and payments, and submit claims online.

Direct Deposit

Does Delta Dental offer payment via Direct Deposit?

Yes, we offer free Direct Deposit to all providers, whether you submit claims electronically or by paper. Sign up today to get your claims payments transferred directly from Delta Dental to your checking or savings account.

What is Direct Deposit?

Direct Deposit is an electronic payment conveniently deposited directly to your checking or savings account.

How soon can I access money after receiving a Direct Deposit payment?

Your money should be available no later than the opening of business on the effective date. Please check with your financial institution.

Do I have to use a certain financial institution to participate in Direct Deposit?

No. You may use any bank or credit union in the United States.

Does Direct Deposit cost me any money?

No. In fact, many financial institutions waive other fees or provide other incentives if you use Direct Deposit. Also, Direct Deposit enables you to avoid the high fees charged by check-cashing services.

Why is a voided check required to enroll for Direct Deposit?

The voided check, or a copy of the check, is used to verify your account number and the institution’s routing transit number to ensure that Direct Deposit is set up accurately.

Can I be sure my privacy is protected?

Direct Deposit transactions are safe and confidential since money transferred electronically is virtually unseen compared to transactions by paper check. Also, federal regulations and banking rules provide strong protections regarding electronic payments.

What if I want to cancel my Direct Deposit?

The authorization form you completed to enroll in Direct Deposit has information as to how to revoke authorization and discontinue participation as well as make any changes.

What should I do if I change financial institutions?

Simply fill out a new Direct Deposit Enrollment Form with your new account and financial institution information, and we will direct the payments to your new account. Be sure to leave the old account open until the first Direct Deposit transaction appears in your new account.

Can I receive Direct Deposit payments to different facilities that have different bank account information?

Yes. You may complete a Direct Deposit Enrollment Form for each facility that has different bank account information, and the payments will be directed appropriately.

What should I do if I have a problem with Direct Deposit (EFT) or Electronic Remittance Advice (ERA)?

Problems with electronic payments are rare and can usually be quickly corrected. If you have a problem, please contact provider relations at profservices677@ddpco.com or 303-889-8677 and one of our provider relations specialists will be happy to help resolve your issue.

Will Delta Dental of Colorado be able to take money out of my account?

No. The only exception would be in the rare case that a duplicate or erroneous entry occurred, and, in such case, Delta Dental of Colorado would contact you to discuss the situation before any action was taken.

What is an Electronic Remittance Advice?

The Electronic Remittance Advice (ERA), or the 835, is the electronic method for providers to receive explanation of benefits (EOB), explanation of payment (EOP), and claims denial information.

I have signed up for Direct Deposit but would also like to sign up for Electronic Remittance Advice (ERA). How do I sign up?

Providers who sign up for Direct Deposit are automatically enrolled to receive Electronic Remittance Advice (ERA).

Will I still receive paper Explanation of Payment (EOP) in the mail if I am signed up to receive Electronic Remittance Advice (ERA)?

No. Providers who sign up for Electronic Remittance Advice (ERA) will no longer receive Explanation of Payments (i.e., check disbursements) via United States Postal Service. To view or print the Explanation of Payment (EOP) statements, please log in to our secure provider portal.

How do I find the Explanation of Payment (EOP) information on the website?

Log in to our secure provider portal to view the Explanation of Payment (EOP) information.