Filing a Claim
If you receive care from a WDS/Delta Dental participating dentist, the dentist will submit a claim for you.
If you receive services from a non-participating dentist, you may be required to pay the dentist in full, and it's your responsibility to submit a claim form to WDS or have the provider submit one for you. Claim forms are available from WDS. (See Contact Information.)
When submitting any claim, you need to include your itemized bill. It should show:
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patient's name;
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provider's tax ID number;
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diagnosis or CDT-7 code;
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date of service/supply; and
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itemized charges from the provider for the services and/or supplies received.
You also need to provide:
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your name (if you're not the patient);
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your Social Security number (or unique identifier number if you've requested one); and
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group number 00152.
For prompt payment, submit all claims as soon as possible. The dental plan won't pay a claim submitted more than six months after the date of service and/or supply. If you can't meet the six-month deadline because of circumstances beyond your control, the claim will be considered for payment when accompanied by a written explanation of the circumstances.
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