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Reconsideration/Appeal Process
for Dental Offices

Occasionally, a dentist or staff member may question the benefit determination of a claim and may wish to submit a request for reconsideration/appeal of the claim.

So that we may make a timely review of all reconsideration/appeal requests we ask for the following:

All reconsideration/appeal requests for pre-determinations or claims are requested to be type-written and to include:

  • A type-written cover letter signed by the treating dentist describing the specific reason why the reconsideration is being requested (including tooth numbers and procedures). The letter should reference the original claim number, patient name, date of service, and current date.
  • Any additional legible clinical record documentation which might support the reconsideration/appeal request. Delta Dental national processing policy only allows dental consultants to consider information contained in the contemporaneous legal clinical record when evaluating reconsideration/appeal requests. Narratives cannot be considered as support for a reconsideration request.

The original benefit determination of the claim or pre-determination will be upheld unless it is found that a specific error was made or additional clinical record documentation supports the request for reconsideration/appeal.

Reconsideration/appeal requests must be submitted within six (6) months of the date of the original explanation of benefits/payment remittance advice.

Dentists should submit their reconsideration/appeal request to:
       Director, Professional Relations
       Northeast Delta Dental
       One Delta Drive
       PO Box 2002
       Concord, NH 03302-2002