Quick Access to Common Resources
Have questions? Visit our Frequently Asked Questions section or contact us.
- Claims and Remittance-Related Resources
- Information about Electronic Claims/ Claims Submission
- Claim Attachment Cover Sheet for Electronic Claims
- Electronic Remittance Advice
- Provider Network Descriptions
- Dental Office Support Resources
- NPI – (National Provider Identifier)
- MHCP Non-Covered Services Form for Participating CivicSmiles providers
- North Dakota CHIPS: Healthy Steps Orthodontic Screening Form
- 2019 Minnesota Filed Fee Schedule
- Delta Dental Individual and Family℠ - Singular Fee Schedule
- International Dental Program Instructions for Dentists
- Identity Theft—Protect Your Practice from Patient Fraud
- Credentialing and Participation Agreements
- MN Uniform Initial Credentialing Application
- ND Uniform Initial Credentialing Application
- Re-Credentialing Application
- Delta Dental PPO™ Participation Agreement
- Delta Dental Premier® Participation Agreement
- Delta Dental CivicSmiles Participation Agreement
- Delta Dental Participation Agreement for Medicare Eligible Plan Discount Program
- State Dental Plan Participation Agreement
- Signature on File
- Network Descriptions
- Medicare
- Medicare Sample Contract
- Organization Determination: Charging patients for non-covered services
- UCare Benefits Grid – 2018
- Confirm Online “Find A Dentist” Directory Information – Medicare
- Medicaid
- Ortho – HLD Index Generic Form
- Minnesota Disclosure of Ownership and Control Interest of an Entity
- North Dakota Disclosure of Ownership and Control Interest of an Entity
- Minnesota Health Care Program Non-pregnant Adult Dental Benefits
- Advance Recipient Notice of Non-covered Service/Item
- SNBC Dental Access Provider Survey Follow Up
- Cultural Competency Training for Oral Health Providers
- MN DHS links on the following topics - Medicaid:
- Complete non-pregnant adult benefit grid
- Covered services for children and pregnant women
- Critical access information for providers
- MHCP Fee Schedule (MHCP Fee Schedule (dental codes begin on page 55 of the PDF)
- ND DHS enrollment resource documents:
- 2018 – Action Needed to Remain in the Delta Dental of Minnesota North Dakota Premier Network
- MCO Communication Delta Dental
- SFN 1168-Notes
- Application Quick Reference Guide