How Do I Submit A Claim For A Child Patient With Adult Dentition?
Did you know that per group contract an Adult is considered age 14 years and older? When submitting an Adult Prophylaxis (D1110) for a child (under the age of 14 years) with full Adult Dentition, you can submit the claim with a narrative stating “Adult Dentition” and the claim will process as submitted.
We want to ensure the services you provide to your patients are received and processed for timely reimbursement. Claims need to be received by Delta Dental within six months of the date of service. Upon appeal, special consideration may be given for claims older than six months as long as these claims are received within 12 months from the date of service. Click here to submit an Online Appeals Form.
Please note: If another insurance plan is primary and does not pay in a timely manner, it is recommended to submit a claim to the secondary payer within 6 months from the original date of service to comply with timely filing requirements. The denial should indicate the need for the primary carrier’s remittance advice. Once the primary carrier pays, include a copy of the primary carrier’s remittance advice and the secondary carrier’s denial (not a new claim) and request reprocessing of the secondary claim.