Notice
Delta Dental of Washington is working to effectively manage the daily changing environment relating to COVID-19/Coronavirus. Our priority is to keep our employees healthy, while also supporting the needs of our members, dentists and communities. As a result of this situation and most recently the governor’s shelter in place order, you may experience extended hold times when calling customer service, or longer turn-around times on other correspondence or claims. This will not impact our website and we encourage you to use DeltaDentalWA.com for benefit, eligibility, and claim information. You can submit questions via email through the “contact us” link located at the top of each page on our website. We apologize for any inconvenience this may cause.
Dental Insurance Forms
Get your claim started by submitting one of the standard forms that relates to your needs.
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Coordination of Benefits Questionnaire
Use this form when coordinating dental benefits with another dental coverage provider (e.g., your spouse's coverage). -
Standard Claim Form (US)
Use this form to file a claim for services performed in the United States. -
Out of the Country Claim Form
Use this form to file a claim for services performed outside the United States. -
HIPAA Authorization Form
Use this form to view overage dependents information or if you're having custody issues.
