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Delta Dental of New York, Inc. ATTENDING DENTISTS STATEMENT P.O. Box 2105 2105 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 the necessary information for the claim, including your personal details, dental office details, and insurance policy information.
02
Carefully read the instructions provided on the claim form to ensure you understand the process and requirements.
03
Fill in your personal details accurately, including your name, address, phone number, and email address.
04
Provide the name and contact information of the dental office where the services were rendered.
05
Enter the details of the dental services received, including the date of service, procedure codes, and a brief description of the treatment.
06
Indicate whether the services were rendered due to an accident or injury, if applicable.
07
If you have primary or secondary dental insurance coverage, provide the necessary information, including the policyholder's name, policy number, and any other details required.
08
Include any supporting documentation, such as X-rays or receipts, if necessary.
09
Review the completed claim form for accuracy and completeness before submitting it.
10
Keep a copy of the filled-out claim form and any supporting documentation for your records.
Who needs 8158 delta dental claim?
01
Individuals who have received dental services from a dental office that accepts Delta Dental insurance.
02
Individuals who have a Delta Dental insurance policy and are seeking reimbursement for the dental services received.
03
Individuals who require documentation of dental services for their insurance records or verification purposes.
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What is 8158 delta dental claim?
8158 delta dental claim is a form used to request reimbursement for dental services provided by a Delta Dental network dentist.
Who is required to file 8158 delta dental claim?
Patients who have received dental services from a Delta Dental network dentist are required to file 8158 delta dental claim in order to request reimbursement.
How to fill out 8158 delta dental claim?
To fill out 8158 delta dental claim, patients must provide their personal information, details of the dental services received, the treating dentist's information, and any supporting documentation.
What is the purpose of 8158 delta dental claim?
The purpose of 8158 delta dental claim is to facilitate the reimbursement process for patients who have received dental services from Delta Dental network dentists.
What information must be reported on 8158 delta dental claim?
Information such as patient's personal details, details of dental services received, treating dentist's information, and any supporting documentation must be reported on 8158 delta dental claim.
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