Claims for all Delta Dental of Idaho subscribers should be mailed to:

Delta Dental of Idaho
P.O. Box 2870
Boise, ID 83701

We encourage electronic submission of claims for faster turnaround time and improved provider cash flow.

We have several options to get answers to your questions.

• Online: You can access benefits and eligibility information and claims status online in the Dentist Log-In section of our website. To access this secure portion of our website, you will need to be registered for online use. If you are not currently registered, you can Register Here.
• ProFax: You can obtain benefits, eligibility, and claims information via your fax by calling (208) 489-3545 or toll-free (866) 452-4154.
• Call Customer Service: Our Customer Service Representatives are available Monday through Thursday from 7:00am to 5:30pm and from 7:00am to 4:00pm on Friday at (208) 489-3580 or 800-356-7586 to assist you with questions.

Delta Dental requires X-rays for the following reasons:

1. For two or more crowns and for all anterior crowns
2. Crown buildups
3. Onlays and veneers
4. Impacted teeth
5. As requested by our Dental Consultant to clarify specific cases

Delta Dental requires perio charting for the following procedure codes:

• D4210 Gingivectomy or Gingivoplasty – four or more contiguous teeth or bounded teeth spaces per quadrant.
• D4211 Gingivectomy or Gingivoplasty – one to three contiguous teeth or bounded teeth spaces per quandrant.
• D4240 Gingival Flap Procedure, including root planing – four or more contiguous teeth or bounded teeth spaces per quadrant.
• D4241 Gingival Flap Procedure, including root planing – one to three contiguous teeth or bounded teeth spaces per quadrant.
• D4260 Osseous Surgery (including flap entry and closure) – four or more contiguous teeth or bounded teeth spaces per quadrant.
• D4261 Osseous Surgery (including flap entry and closure) – one to three contiguous teeth or bounded teeth spaces per quadrant.
• D4341 Periodontal Scaling and Root Planing – four or more teeth per quadrant.
• D4342 Periodontal Scaling and Root Planing – one to three teeth per quadrant.

Standard processing provides for an initial payment and periodic payments for orthodontic treatment. Once benefits are established for a case, payments are issued automatically.

Delta Dental members with the value added orthodontic discount program experience substantial savings because Idaho orthodontists in the Orthodontic Discount Program agree to discounted fees. The discount is based on the length of treatment.

The process to contract with Delta Dental requires a signed agreement and a credentialing process. Please call Delta Dental Provider Services at 800-356-7586.

There are several ways to submit claims to Delta Dental of Idaho.

• Online: We provide free claims submission online. Simply click on the Claims option after logging in to the secure Dentist section of our website and then click "Submit New Claim."
• Electronically: We accept electronic claims through Emdeon, Dental Xchange, and Tesia. Our Payer ID # is 82029. We also accept electronic attachments through National Electronic Attachments (NEA), NIS, and Emdeon.
• Mail: You can mail paper claims to: Delta Dental of Idaho, P.O. Box 2870, Boise, ID 83701.

Currently, Delta Dental processes all claims in less than three (3) business days on average from the date the claim is received. Payments are issued weekly.

The co-payment, deductibles and charges for any non-covered services.

Delta Dental has a Dental Advisory Committee, which includes licensed dentists in private practice. The Committee recommends policy adoption or changes based on generally accepted dental practice and changes to the ADAs Common Dental Terminology (CDT) codes. Some policies may also be developed by the National Delta Dental Plans Association Dental Policy Committee and adopted by Delta Dental of Idaho.

If the treating dentist is participating with both PPO and Premier plans, and the dental coverage is PPO, payment is based on PPO fees. If the dentist is Premier-only, payment is based on Premier fees. Coverage can vary by plan.

When claims are processed, you will receive a Claim Payment Statement. This statement explains how the services were processed. If you disagree with the processing outcome of the claim, you may supply Delta Dental with additional information to support the services rendered and we will review the claim with a Dental Consultant, using the additional information, the processing policies and the group purchaser’s contract.

Fees are reviewed annually by Delta Dental and may be changed based on market conditions and claim analysis.

In most instances, the employer group, who is purchasing dental benefits for their employees, is the decision-maker regarding the benefits (co-pays, deductibles and maximums) to be offered to their employees.

Yes! Visit http://www.deltadentalid.me/ for more information and to enroll.

To order additional Individual and Family Plan brochures, please visit http://reorder.rgcnet.com/.