Filing a dental insurance claim might sound overwhelming, but the good news is, you’ll rarely have to do it yourself. In most cases, your dental provider will handle the claim on your behalf.
However, there may be times when you will need to file a claim on your own, such as if you receive treatment while traveling out of the country or if you receive services from a non-cooperative out-of-network dental provider who decides not to accept dental insurance. When that happens, it’s important to understand the process to ensure you’re reimbursed accurately and on time under your dental plan.
In this guide, we’ll walk you through the key steps in preparing and filing a dental insurance claim, so you feel confident and prepared if the need ever arises.
Steps to file a dental insurance claim
Follow the steps below to file a dental insurance claim. If you have any questions, be sure to contact our local DDNM customer experience team for help. You may also find helpful information online on our website.
1. Know your dental coverage
Before filing an insurance claim, familiarize yourself with the details of your dental insurance coverage by understanding your covered benefits, maximum annual limits, frequency limitations, and cost-sharing obligations as described in your Summary of Benefits, Benefits Handbook, or Evidence of Coverage. Being well-informed will empower you to make the right decisions about your dental care and will help you with your claims.
2. Confirm eligibility and coverage
Ensure that the dental services that you received for the claim are covered. Verify your eligibility and check if any prior-authorization or pre-notification is required for specific treatments. This step helps prevent surprises and ensures a smoother claims process.
3. Obtain necessary documentation
After receiving dental services, ask your treating dental provider to provide you with an itemized statement or invoice as well as any related dental records, x-rays, treatment plans, or other information. This is your information and will help us expedite the process of processing your claim for reimbursement.
4. Complete a dental insurance claim form
Delta Dental of New Mexico provides a standard dental claim form online. Complete the insurance claim form accurately, providing all the required information. Include your name, policy number, the treating dental provider’s information, and the specifics of the dental services received.
If you receive treatment from an out-of-network dental provider who will not file the claim for you, you will need to designate whether reimbursement should be sent directly to you or to the out-of-network dental provider. Let the out-of-network dental provider know if they do not cooperate and coordinate with you and Delta Dental of New Mexico, then reimbursement will not be made directly to the out-of-network dental provider. You will receive an explanation of benefits indicating whether reimbursement was made to you or the non-participating provider.
5. Attach supporting documents
Be sure to include supporting records and documents with your claim form. This may include the itemized statement from your dental provider, X-rays, or any other documentation. Ensuring that all required information is attached will expedite the processing of your insurance claim.
6. Submit the insurance claim
Submit your completed dental claim form and supporting documents to Delta Dental of New Mexico. This can be done using our online member portal. Be sure to retain copies of all submitted documents for your records.
7. Monitor the claims process
Once your insurance claim is submitted, monitor its progress. Delta Dental of New Mexico provides an online portal and local customer service team, each of which can be used to check the status of your claim. If there are any delays or issues, don’t hesitate to contact us for more information.
8. Review the Explanation of Benefits (EOB)
After processing your claim, Delta Dental of New Mexico will send you an Explanation of Benefits. This document outlines the details of your insurance claim, including the covered amount, any deductibles, and any out-of-pocket expenses.
9. Address discrepancies or appeals
If you notice any discrepancies in the EOB or if your claim is denied, feel free to contact us for clarification.
Feel confident when filing a Delta Dental of New Mexico dental insurance claim
Filing a dental insurance claim doesn’t have to be a complex process. By following these steps and staying proactive, you can navigate the claims process with confidence. Remember, clear communication with your dental provider and Delta Dental of New Mexico is key in ensuring a smooth and successful claims experience.