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Delta Dental of Pennsylvania ATTENDING DENTISTS STATEMENT One Delta Drive Mechanicsburg, PA 170556999 ×717× 7668500 ×800× 9320783 TTY×TDD 8883733582 www.deltadentalins.com SIGN BELOW FOR PREDETERMINATION
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How to fill out 8158 delta dental claim
How to fill out 8158 delta dental claim:
01
Start by gathering all necessary information, such as your insurance policy details, dental treatment information, and any relevant dental forms.
02
Begin filling out the 8158 delta dental claim form by providing your personal information, including your name, address, and contact details.
03
Next, enter your insurance information, including policy number, group number, and any other required information specific to your delta dental plan.
04
Provide details about the dental treatment received, including the date of service, name of the dentist or dental office, and a description of the treatment.
05
Fill in the treatment charges and fees as specified by your dentist. Ensure accuracy and double-check all amounts entered.
06
If any additional documentation is required, such as X-rays or treatment notes, ensure they are properly attached to the claim form.
07
Review the completed form for any errors or missing information. Make necessary corrections if needed.
08
Sign and date the form to certify that the information provided is accurate and complete.
09
Keep a copy of the completed claim form for your records before submitting it to Delta Dental.
10
Submit the completed claim form either online or by mail, following the instructions provided by Delta Dental.
Who needs 8158 delta dental claim:
01
Individuals who have received dental treatment covered by their Delta Dental insurance plan may need to fill out the 8158 delta dental claim form.
02
It is typically required when seeking reimbursement for dental services received from a non-participating dentist or out-of-network dental provider.
03
If you have a Delta Dental plan that offers out-of-network benefits or if you have visited a dental provider that is not within the Delta Dental network, you may need to complete the 8158 delta dental claim form to request reimbursement for the dental services you received.
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What is 8158 delta dental claim?
8158 delta dental claim is a form used to submit dental claims to Delta Dental for reimbursement of services provided.
Who is required to file 8158 delta dental claim?
Dental providers who have provided services covered by Delta Dental insurance are required to file 8158 delta dental claim.
How to fill out 8158 delta dental claim?
To fill out 8158 delta dental claim, dental providers must include patient information, details of services provided, fees charged, and any supporting documentation.
What is the purpose of 8158 delta dental claim?
The purpose of 8158 delta dental claim is to request reimbursement from Delta Dental for dental services provided to patients.
What information must be reported on 8158 delta dental claim?
Information such as patient name, insurance policy number, date of service, description of services provided, fees charged, and provider information must be reported on 8158 delta dental claim.
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