BENEFITS INC. Payer Name Payer ID 07000 DELTA DENTAL INSURANCE OF MN CDMN1 DELTA DENTAL INSURANCE OF NE 07027 FLEX COMPENSATION R7004 eClaims & Claims Status Dental Payer List Information For any questions please contact eServices Support at 800.475.5036. Box 43026 Phoenix, AZ 85080 800-352-6132 www.deltadentalaz.com Payer #86027 Delta Dental of Arkansas P.O. Box 997330 Sacramento, CA 95899-7330 888-DELTA CS 888-335-8227 DeltaUSA inquiries: Gender U 22. Does this include DeltaCare USA utilization/encounter submissions? Electronic Data Interchange (EDI) Hours and Information. Payer ID Payer Name CDKS1 Delta Dental of Kansas(Whichita, KS) 94276 Delta Dental of Louisiana(Irving, TX) ... CB833 Medical Mutual of Ohio (MMO) 65978 Metlife (El Paso, TX) 79480 Midwest Security of WI (Onalaska, WI) 23166 NAS (Nat'l Auto Sprinklers (Landover, MD) Box 15965 N. Little Rock, AR 72231-5965 800-462-5410 www.deltadentalar.com Payer #CDAR1 Delta Dental of California P.O. Box 30416 Lansing, MI 48909-7916 (800) 524-0149 Delta Dental of Michigan www.deltadentalmi.com Delta Dental of Ohio www.deltadentaloh.com Delta Dental of Indiana J430 (Same as ADA Dental Claim Form – J431, J432, J433, J434, J430D) To reorder call 800.947.4746 or go online at adacatalog.org fold fold fold fold Dental Claim Form U 7. Request a Payor If the insurance company you work with isn’t on the list or if they are on the list, but don’t provide the service you want, tell us about it. When submitting an electronic claim to Delta Dental, please use the following payer ID number: 91062. Payer IDs. Payer Name State Payer ID LOB Transaction Method Info Updated (NLH) Netcare Life and Health Insurance: 66055: Dental: Claims: 7/25/2016: 1199 National Benefit Fund Electronic Services Available (EDI) Electronic Remittance (ERA) This insurance is also known as: Delta Dental of Ohio Box 9085 Farmington Hills, MI 48333-9085 Delta Dental Attn: Customer Service P.O. Delta Dental of Minnesota Electronic Remittance Advice (ERA) Enrollment Form Complete all applicable fields. No, this would only apply to your DeltaCare DHMO patients listed on your Delta Dental of Illinois monthly roster. Submit Completed Document: Email to Tesia . Gender M F M F U Delta Dental of Michigan PO Box 9085 Farmington Hills, MI 48333-9085 You can search by payor ID or Payor Name for payers that accept electronic claims and attachments, or that provide electronic insurance eligibility verification. Delta Dental Plan of Alabama (DDIC) 01031 DeltaCare USA (Formerly PMI)(Claims Only) 01025 Delta Dental Plan of Alaska (DDIC) 01038 DeneX/SG 00957 Delta Dental Plan of Arizona 86027 DentaBenefits 89070 Delta Dental Plan of Arkansas 00001 Dental Benefit Providers 52133 (+)/(ID) = Additional special enrollment required for payer maiL cLaims To: maiL inQUiries To: TeLepHone for eLigiBiLiTy anD BenefiT info Delta Dental P.O. Box 2870 Boise, ID 83701 800-356-7586 deltadentalid.com Payer #82029 Illinois Delta Dental of Illinois P.O. Payer List Includes (20 pgs): Commercial Payers Blue Cross Blue Shield Payers Delta Dental Payers Medicaid Payers Payer ID 06126: Use this eClaim payer id for those insurance companies that are not on the eClaim Payer List If you conduct electronic transactions, you’ll need the Payer ID of the insurance carrier. More than 3,400 dentists are submitting their claims electronically to Delta Dental. registrations@tesiasupport.com . Please continue to use the Payer ID 05030 for any DeltaCare DHMO specialty claims you submit on behalf of your specialists. Gender M F 14. Delta Dental claim form; For DeltaCare USA claims and encounters. Link to ... DPO and Delta Dental Premier claims. Payer #99010 Idaho Delta Dental of Idaho P.O. Payer #CDOR1 Delta Dental of Arizona P.O. 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