The following are commonly asked questions by Member Dentists
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Online account questions
How do I change the email preferences, including the email address I provided, upon initial registration on your website?
1. Sign in to your account at DeltaDentalWA/Provider.com.
2. On the upper right-hand corner of the screen, select My Account.
3. From the menu presented, select Mobile & email.
4. Click the panel displaying your email address and you will be able to make your update.
How do I change the password on the account I created?
To change your password, please sign in to your account at DeltaDentalWA.com\Provider. On the upper right hand corner of the screen select My Account. From the menu presented, select Password & security. Enter your current password and the new password you would like to update on your account.
Why am I asked for a default provider when registering?
Selecting a default provider connects the user account you are creating to that provider. This also ensures the fees displayed in Fee View are for the provider selected.
Benefits and eligibility
How can we obtain benefit information for our patients without waiting on the phone?
There are four easy-to-use options available:
My benefits page is not printing correctly, how do I get everything on the page to display when printing?
To view all benefits, change your print preferences to landscape. This allows all of the information to fit on the page.
The Interactive Voice Response System (IVR) states that there is an ‘Eligibility through Date’ of 06/30/2020, what does this mean?
The eligibility through date on the fax back indicates the system can confirm eligibility and benefits through the end of the month. If the individual you are inquiring about has not had any coverage/employment changes after the end of the month, they will still be eligible for coverage.
Is there a missing tooth clause?
No, there is no missing tooth clause.
Can all four quadrants be done on the same day for procedure code D4341?
Yes, and they are subject for review.
What is the claims mailing address?
Our claims mailing address is:
Delta Dental of Washington
P.O. Box 75983
Seattle, WA 98175
What if there's additional information I feel is pertinent to processing a specific claim?
To make sure additional information is seen on your claim or predetermination submission, add one of the following key words in the comments/remarks section:
Do you pay on the prep or seat date for a crown?
We make benefit determination based on seat/complete date.
When do we need to submit x-rays?
Click here for our current documentation requirements.
What is the process of submitting Orthodontia claims?
Submit one claim to us for the entire treatment case, we’ll take care of the rest. It is important that you do not send continuation claims for the remainder of treatment. We will set up orthodontia continuation claims to pay automatically based on your patient’s payment schedule. If you don’t receive payments, call our customer service team at (800) 554-1907 or open a web chat session when you sign into your account. Click on the green chat button on the right-hand side of your screen and enter any question from claim status. You can open a chat session and leave it open all day, asking questions and receiving answers as needed.
When submitting your full case set-up claim, please be sure to include:
Where can I periodically review information about the Clinical Review process at Delta Dental?
You can view current clinical review and policy information by selecting the Clinical Information drop down in the menu, after you sign in to your account at DeltaDentalWA.com/Provider.
If I submitted incorrect information on a claim, what is the best way to submit a corrected claim so I don’t have to call customer service?
If you need to submit a corrected claim, submit it the same way as you did the original claim with what needs corrected in the remarks/comments section. For example: Claim #123456789123456 submitted with tooth #15 in error. Please reprocess D7140 using tooth #16. Without clearly noting what needs adjusted, and adding the word corrected in the remarks section, it may be processed as a duplicate claim.
If my patient has Dual Delta Dental Coverage do I need to submit two claim forms?
No, submit one claim with all secondary coverage information listed. We’ll automatically process through both Delta Dental of Washington plans.
Should I highlight important information on claim forms before sending them in?
No. Highlighting data on the claim forms causes information to be unreadable when the claims are scanned.
How long should I wait to receive payment or denial on a claim before I resubmit the claim or contact customer service?
We have 30 days to process claims, though we typically process claims much faster than that. If you have not received a payment or denial, please wait 30 days before resubmitting them or calling customer service to inquire about their status. You can verify claim status on our website or IVR.
Are there any restrictions to sealants?
Sealants are covered on permanent molars with no restorations or decay on the occlusal surface.
Should I include the primary carrier’s explanation of benefits (EOB) when submitting a claim if you are the secondary carrier?
Yes. You should always include the primary carrier’s EOB when submitting your patients’ claims to us if we are secondary. This will reduce requests for additional information and help ensure that your claims are processed quickly and accurately.
Medically Necessary Orthodontic Treatment
What is considered "medically necessary" orthodontia?
The Medical Necessity Standard defines “medical necessity” as medical conditions listed on the Delta Dental Orthodontic Form for Medical Necessity or uses as a guide the Washington Modified Handicapping Labiolingual Deviation (HLD) Index Score that result in a score of 25 or higher.
Delta Dental of Washington reviews all requests for treatment for conditions that result in a score of less than 25 on a case by case basis with consideration of medical necessity.
What are the medical conditions listed on the Delta Dental Orthodontic Form?
Where can I find your Orthodontic Form for Medical Necessity?
The form is available here, or by clicking Resources in the navigation bar and scrolling down to 'Delta Dental Orthodontic Medical Necessity.'
What supporting documentation is required to assist in determining Orthodontia Medical Necessity?
Documentation requirements include the Delta Dental Orthodontic Form for Medical Necessity and a full series of orthodontic photographs (includes three extraoral and five intraoral, including occlusal views).
What is the best way to submit the required supporting documentation for Medically Necessary Orthodontia?
The Delta Dental Orthodontic Form for Medical Necessity and the full series of orthodontic photographs should be submitted electronically via Fast Attach services provided by National Electronic Attachments (NEA).
Does Medically Necessary Orthodontia require preauthorization or confirmation of treatment and cost (also called a predetermination)?
Preauthorization is required for medical necessity determination.
A Predetermination/Confirmation of Treatment and Costs may be required for non-medically necessary orthodontics. Please check the plan specific requirements by signing in to your account on our website, or calling customer service.
I am a Delta Dental member dentist, which networks do I belong to?
When you become a Member Dentist with Delta Dental, you are automatically a member of the Delta Dental Premier® network. You must apply separately for any other network(s) you would like to join. If you're not sure which networks you have joined, you have two ways to check:
I am a member at one dental office. Does that mean I'm automatically a member at all of my offices?
No. Delta Dental membership, and membership in any provider network, is per location. If you want to be a member dentist in any or all of our networks at multiple locations, you must apply separately for each location.
Do dental associates working under my Tax ID Number need to be members?
Yes, your employees do need to be Member Dentists.
According to updated information, the associate provider needs to be in network with Delta Dental of Washington. The claim must be submitted with the billing entity on the lower left portion of the claim form and the rendering provider must have their information on the lower right portion of the claim form. If the rendering provider is not in network at that location the claim will process out of network. Your membership is determined per provider, per location.
Can I access membership applications online?
Yes. Our membership applications are available here. You can complete the application, sign, and submit through DocuSign.
If you prefer to complete a paper application, print the form from the page, complete it, and send by fax to (800) 460-3159.
The PPO application is available online. Simply login to your account, select Provider Contracts and PPO Provider Agreement. You can also obtain a copy by contacting our Provider Services team at (800)238-3439.
I am changing or have changed my Tax ID Number. What's next?
You will need to complete a Tax Identification Change Notification. Find the form online here or visit our website, select the Forms page and scroll down to ‘Tax Id Number Change Notification’. Complete your information using the secure DocuSign form and submit. If you prefer, you can print the form, fill it out and fax the form to Provider Services at (800) 460-3159.
Can a Customer Service representative give me my filed fees?
No. Our Customer Service representatives can only verify your fee if they are researching a procedure your office has submitted. They can tell you whether the correct fee was applied by our computer information system.
What is a Maximum Allowable Fee?
We assign fees for the more common procedure codes. Your payment is based on the assigned fee. In the absence of an assigned fee for a specific procedure code, the benefit determination (payment) is based on an established maximum allowable fee.
Can you tell me the Maximum Allowable Fee over the phone?
Member Dentists can view the maximum allowable fee for a procedure code by using the Fee View application. This tool is available after you sign in to your account at DeltaDentalWA.com/Provider, select View Current Fees, select a network to view fees and click Fee Lookup.
How can I get my question answered if I don't have time to hold on the phone?
If you need the answer to a simple question and you don't see it in these FAQ's, you can e-mail us at CService@DeltaDentalWA.com and we'll respond to your question within one business day. Or you can call Customer Service at (800) 554-1907 or open a web chat session when you sign into your account. Click on the green chat button on the right-hand side of your screen and enter any question from claim status, check patient benefits, payment voucher questions, DeltaCare exceptions and more. You can open a chat session and leave it open all day, asking questions and receiving answers as needed.
I want to sign in with another account but the website won’t give me a login page, what do I do?
This means you are still logged in with your first account. This happens when you close out of the browser, without signing out. First, you will need to sign out to access another account. To do this, select My Account from the upper right hand corner of the screen and click the Sign Out button at the bottom of the menu presented.
Now, you will be able to sign in using another account.
What is Delta Dental of Washington Payer ID?
Where can I review the Delta Dental processing policies?
The Delta Dental Processing Policy Manual is available to Member Dentists and is in the Provider Library section of our website under Manuals.
My office is interested in new products and procedures, what are the DDPA guidelines for covering such treatment?
To be considered for coverage, new products and procedures must be proven and accepted as valid and effective based on the body of scientific evidence of effectiveness as reported in high quality refereed scientific literature. To learn more about the DDPA guidelines for New Dental Product and Technology Adoption Guidelines, visit the Clinical Criteria Requirements page, which is located in the Clinical Information tab.
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