Get the free 8158 Delta Dental Claim Form

Delta Dental of New York, Inc. ATTENDING DENTIST S STATEMENT P.O. Box 2105 Mechanicsburg, PA 17055-6999 (717) 766-8500 (800) 932-0783 TTY/TDD 888-373-3582 www.deltadentalins.com SIGN BELOW FOR PREDETERMINATION

How to fill out 8158 delta dental claim

How to fill out 8158 delta dental claim:

1. Start by gathering all the necessary information, such as your personal details, dental provider information, and treatment details. This will help ensure accurate and timely processing of your claim.
2. Open the 8158 delta dental claim form and carefully read the instructions provided. Familiarize yourself with the various sections and requirements.
3. Begin by entering your personal information, including your name, address, date of birth, and contact details in the designated fields. Make sure to double-check the accuracy of the information provided.
4. Next, provide the details of your dental provider, including their name, address, and contact information. This will help Delta Dental easily communicate and coordinate the claim with your dental office.
5. Specify the treatment details by listing the date of service, the procedures performed, and the corresponding codes. Delta Dental typically requires specific dental procedure codes, so ensure you have the correct codes from your dental provider.
6. Indicate whether there are any other dental or medical coverages that apply to your claim. If you have dual coverage, additional information may be required.
7. Carefully review the completed claim form, ensuring that all the information provided is accurate and complete. Any incorrect or missing information could delay the processing of your claim.
8. Attach any supporting documentation required, such as dental treatment notes, X-rays, or invoices, as specified by Delta Dental.
9. Sign and date the claim form, confirming the accuracy of the information provided and authorizing Delta Dental to process the claim.
10. Finally, submit the completed claim form and any supporting documents via mail or electronically, as instructed by Delta Dental.

Who needs 8158 delta dental claim:

1. Individuals who have received dental treatment covered by their Delta Dental insurance policy and need to submit a claim for reimbursement.
2. Individuals who have dual dental coverage and need Delta Dental to coordinate benefits with their secondary dental insurance carrier.
3. Individuals who have questions or concerns regarding their dental claim and require assistance from Delta Dental's customer service.

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