Help Center: Dentists


Does Delta Dental of Virginia accept electronic claims?

Yes, we accept electronic claims from a variety of clearinghouses, including DentalXChange, Change Healthcare and Tesia. Our Payer ID# is 54084. Delta Dental Premier® and Delta Dental PPO™ participating providers can also submit claims online by logging into our secure dentist page.

What if I use a clearinghouse not included in your list of accepted clearinghouses?

Delta Dental of Virginia can accept claims from a variety of clearinghouses, including DentalXChange, Change Healthcare and Tesia. If you use a different clearinghouse than what is listed here, contact our Claims Department to see if we can accept claims from your current clearinghouse. You may also submit claims online in real-time by logging in as a dentist, or you can print them to paper and mail or fax them to us at:

Delta Dental of Virginia
ATTN: Claims Department
5415 Airport Rd 
Roanoke, VA 24012
Fax: 540-491-9717

How do I submit claims to Delta Dental?

We can accept your claims electronically, by fax, or by mail. To submit claims electronically log in as a dentist. Claims can also be mailed or faxed to:

ATTN: Claims Department
Delta Dental of Virginia
5415 Airport Road
Roanoke, VA 24012
Fax: 540-491-9717

What should be included on claim forms to Delta Dental?

Be sure to include the following on all claim forms:

•    Subscriber's name, address, date of birth and identification number
•    Patient's name and date of birth
•    Patient’s relationship to subscriber
•    The dentist's complete license number
•    The dentist’s EIN (TIN or SSN)
•    National Provider Identifier (NPI)
•    Narratives, X-rays and intra-oral photos (please refer to your provider manual for procedures requiring this documentation)
•    Dates of service (completion or delivery dates) for multiple visit services
•    Tooth numbers or quadrants and indicate tooth surfaces where applicable
•    Complete dual coverage information, including the subscriber's identification number and date of birth, and attach the primary carrier's statement (if applicable).

Should I also send a paper claim to Delta Dental if I have sent one electronically?

To ensure quick processing, please do not submit paper claims in addition to electronic claims. You can check the status of your submitted claims quickly and easily by logging in to our dentist site.

How do I check the status of a claim?

You can check the status of your claims 24/7 through our secure dentist site. Simply log in and a list of your recent claims will appear, or you can search all claims by clicking on the Claims tab. You can also check claim status through our Interactive Voice Response System (IVR) by dialing 800-367-3531 and pressing “1" for claim status. Please do not send in duplicate claims if the claim is showing in our system, as it will delay the process.

Does Delta Dental of Virginia accept electronic attachments?

Yes, we accept electronic attachments through National Electronic Attachments (NEA). Please note, the NEA attachment number must be referenced on the claim in the notes section. If you receive a "Request for Additional Information" from Delta Dental, you may submit an electronic attachment without a claim if you submit the claim number with the attachment. Please do not send an electronic attachment without a claim or without reference to a Delta Dental claim number.

How do I find out more about filing electronic attachments from my office?

In order to submit electronic attachments, you will need equipment that produces an electronic copy of a document or image. The type of equipment and other requirements depends on which vendor you choose to support this capability. Check with your practice management software vendor for more details. You can also contact National Electronic Attachments (NEA) for more information.

What procedures require radiographs?

The following procedures require radiographs to be submitted with the claim:

•    Some periodontal procedures
•    Surgical extractions
•    Crowns, core build-up, cast or prefab post and core
•    Bridges
•    Inlays, onlays and veneers
•    Implants

If you have any questions about whether a specific procedure requires radiographs to be submitted with the claim, please refer to your Provider Manual or call us at 800-367-3531.

Radiographs should be submitted as follows:

•    Mounted,
•    Dated,
•    Labeled left to right, or with tooth numbers, and
•    Identified on the X-ray with the patient name, dentist name, and phone number.

Radiographs will not be returned unless submitted with a self-addressed return envelope. Please make sure to send copies of your original X-rays. Delta Dental is not responsible for returning X-rays and will not do so unless they are submitted with a self-addressed return envelope.

What procedures require narratives?

The following procedures require narratives to be submitted with the claim:

•    Implants - Indicating medical necessity
•    Any procedure code ending in 99 – Miscellaneous codes
•    Any CDT procedure code that has 'by report' in the descriptor
•    Other procedures that are unclear or require dental necessity rationale

What procedures require periodontal charting?

The following periodontal procedures require periodontal charting: CDT Codes 4210; 4211; 4230; 4231; 4240; 4241; 4245 ; 4260; 4261; 4263; 4264; 4266; 4267; 4270; 4273; 4275; 4276; 4277; 4278; 4341; and 4342.

What is the correct date of service for multiple visit procedures (root canals, crowns, fixed and removable prosthetics)?

The correct date of service is the final fill date, the cementation date and/or the delivery date. Delta Dental will only pay for completed dental services.


If I participate with Delta Dental of Virginia, do I participate with all other Delta Dental member companies?

Yes. By signing a Delta Dental of Virginia Participating Provider Agreement, your participation is honored throughout the national Delta Dental system. Please keep in mind that if your patient is covered under a Delta Dental National Coverage plan, claims must be submitted to the appropriate Delta Dental member company for processing. You are still guaranteed direct payment and Virginia Maximum Plan Allowances (MPA) for these claims.

What is the difference between Delta Dental Premier and Delta Dental PPO?

Delta Dental Premier® is the largest dental network in Virginia and across the nation. This traditional fee-for-service program guarantees participating providers direct reimbursement based on the lesser of their submitted fee or Delta Dental of Virginia’s Maximum Plan Allowance (MPA). Subscribers with Delta Dental Premier plans experience lower out-of-pocket costs when visiting a Delta Dental Premier participating provider.

Delta Dental PPO™ is our preferred provider network. This reduced fee-for-service program guarantees participating providers direct reimbursement based on the lesser of their submitted fee or the Delta Dental PPO fee schedule. Employers actively encourage their employees to select Delta Dental's PPO network dentists because their out-of-pocket expenses may be lower.

Note: Please make sure to check your patient’s ID card to ensure that you participate in the Delta Dental network covered by their plan. Get more information on our plans and networks.

What are the advantages of participating with Delta Dental Premier?

Delta Dental Premier® participating providers are guaranteed direct payment for services rendered to Delta Dental Premier patients. This will save you a significant amount of time, as well as reduce your billing costs. Your name is also published as a participating Delta Dental Premier provider in directories sent to our groups, as well as on our website. Delta Dental Premier subscribers generally have reduced out-of-pocket expenses when they visit Delta Dental Premier participating providers.

What reimbursement will I receive as a Delta Dental Premier participating provider?

Delta Dental of Virginia's reimbursement is based on the Maximum Plan Allowance (MPA) concept. Our MPAs are based on geographical regions and specialty training. Due to provisions of federal anti-trust laws, Delta Dental is prohibited from publishing MPAs.

What are the advantages of participating with Delta Dental PPO?

Delta Dental PPO™ providers enjoy all the advantages of a Delta Dental Premier provider. Additionally, PPO plans are the most common plan chosen by employer groups and their employees are encouraged to seek care from Delta Dental PPO providers because, when they do, their out-of-pocket costs are usually lower. Employers and employees alike are becoming savvier than ever, resulting in more patients choosing PPO.

What reimbursement will I receive as a Delta Dental PPO participating provider?

Delta Dental of Virginia’s PPO reimbursement is based on a published fee schedule. Fees are based on geographical regions and specialty training.

How do I become a Delta Dental participating provider?

To become a Delta Dental participating provider, please complete and submit the following:

•    Delta Dental Premier and PPO Participation Packet
•    A copy of your DEA license
•    Proof of malpractice insurance coverage

How can I view the PPO fee schedule for my region?

Please call Provider Relations at 800-367-3531, to get a Delta Dental PPO™ fee schedule and contract.

If I am a participating Delta Dental provider, do I also participate with the TRICARE Retiree Program?

DeltaSelect TRICARE Retiree Dental Program is now considered a Delta Dental PPO™ program. This means all participating Delta Dental dentists will receive direct payment according to Delta Dental of Virginia allowances. For those dentists that are participating with the Delta Dental PPO program, you are considered in-network for TRICARE Retiree Dental Program patients.

How do I determine patients' benefits and eligibility?

You can access your patients’ benefits quickly and easily by logging into our secure dentist site, where you can check benefits and eligibility, claims status and payments, and submit claims online.

Direct Deposit

Does Delta Dental offer payment via Direct Deposit?

Yes, we offer free direct deposit to all dentists, whether you submit claims electronically or by paper. Sign up today to get your claims payments transferred directly from Delta Dental to your checking or savings account.

What is direct deposit?

Direct Deposit is an electronic payment conveniently deposited directly to your checking or savings account.

How soon can I access money after receiving a Direct Deposit payment?

Your money will be available no later than the opening of business on the effective date.

Do I have to use a certain financial institution to participate in Direct Deposit?

No. You may use any bank or credit union in the United States.

Does Direct Deposit cost me any money?

No. In fact, many financial institutions waive other fees or provide other incentives if you use Direct Deposit. Also, Direct Deposit enables you to avoid the high fees charged by check-cashing services.

Why is a voided check required to enroll for Direct Deposit?

The voided check, or a copy of the check, is used to verify your account number and the institution’s routing transit number to ensure that the direct deposit is set up accurately.

Can I be sure my privacy is protected?

Yes. Your transactions are safe and confidential since money transferred electronically is virtually unseen compared to transactions by paper check. Also, federal regulations and banking rules provide strong protections regarding electronic payments.

Once you sign up, your information becomes part of an electronic transaction that is sent through a safe and secure network. In fact, fewer people see your information with direct deposit compared to paper check processing.

What if I want to cancel my direct deposit?

The authorization form you completed to enroll in Direct Deposit has information as to how to revoke authorization and discontinue participation as well as make any changes.

What should I do if I change financial institutions?

Simply fill out a new Direct Deposit Enrollment Form with your new account and financial institution information and we will direct the payments to your new account. Be sure to leave the old account open until the first direct deposit transaction appears in your new account.

Can I receive Direct Deposit payments to different facilities that have different bank account information?

Yes. You may complete a Direct Deposit Enrollment Form for each facility that has different bank account information and the payments will be directed appropriately.

What should I do if I have a problem with Direct Deposit (EFT) or Electronic Remittance Advice (ERA)?

Problems with electronic payments are rare and can usually be quickly corrected. If you have a problem, please contact 540.989.8000 ext. 3328 and one of our Provider Relations Specialists will be happy to help resolve your issue.

Will Delta Dental of Virginia be able to take money out of my account?

No. The only exception would be in the rare case that a duplicate or erroneous entry occurred and, in such case, Delta Dental of Virginia would contact you to discuss the situation before any action was taken.

What is an Electronic Remittance Advice?

The Electronic Remittance Advice (ERA), or the 835, is the electronic method for providers to receive explanation of benefits (EOB), explanation of payment (EOP) and claims denial information.

I have signed up for Direct Deposit, but would also like to sign up for Electronic Remittance Advice (ERA). How do I sign up?

Providers who sign up for Direct Deposit are automatically enrolled to receive Electronic Remittance Advice (ERA).

Will I still receive paper explanation of payment (EOP) in the mail if I am signed up to receive Electronic Remittance Advice (ERA)?

No. Providers who sign up for Electronic Remittance Advice (ERA) will no longer receive Explanation of Payments (EOPs) via United States Postal Service. To view or print the Explanation of Payment (EOP) statements, please log into our dentist portal.

How do I find the Explanation of Payment (EOP) information on the website?

Log into our dentist portal to view the Explanation of Payment (EOP) information.