CA Delta Dental 1213 2020 free printable template
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PROVIDER INQUIRY FORM
INSTRUCTIONS
Delta Dental requires providers use a resubmission request by selecting that option on this form to resubmit claims
for clerical corrections, or to provide additional
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How to fill out 130941provider inquiry formdelta 1213
How to fill out CA Delta Dental 1213
01
Gather necessary personal information such as your name, address, and Social Security number.
02
Obtain your dental coverage information from Delta Dental, including your subscriber ID.
03
Fill out the personal information section at the top of the form accurately.
04
Complete the section for dental services provided, specifying the type and date of service.
05
If applicable, provide details about the dentist or dental provider.
06
Review the form for any required signatures, ensuring everything is signed where indicated.
07
Submit the form according to the instructions included, either by mail or electronically.
Who needs CA Delta Dental 1213?
01
Individuals enrolled in a Delta Dental plan who need to file a claim for dental services received.
02
Patients who have received dental treatments and wish to receive reimbursement from Delta Dental.
03
Dentists or dental offices submitting claims on behalf of their patients under Delta Dental coverage.
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What is CA Delta Dental 1213?
CA Delta Dental 1213 is a form used by dental providers in California to report dental care services for insurance claims.
Who is required to file CA Delta Dental 1213?
Dental providers and practitioners who offer services covered under California's Delta Dental plan are required to file CA Delta Dental 1213.
How to fill out CA Delta Dental 1213?
To fill out CA Delta Dental 1213, providers need to enter patient information, details of dental services provided, diagnosis codes, and the provider's information accurately on the form.
What is the purpose of CA Delta Dental 1213?
The purpose of CA Delta Dental 1213 is to facilitate the processing of dental claims and to ensure that providers are reimbursed for the services rendered to patients.
What information must be reported on CA Delta Dental 1213?
The information that must be reported on CA Delta Dental 1213 includes patient demographics, treatment dates, procedure codes, diagnosis codes, and billing details.
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