DeltaCare® is a dental HMO that offers maximum cost savings for employers and enrollees while assuring quality controls. The DeltaCare network has dentists practicing in over 61,000 locations nationwide.

Click on the links below to view the documents. 

Encounter Form

Specialty Listing

DeltaCare Electronic Claim Submissions

DeltaCare Specialty Claim Form

This claim form is for DeltaCare specialty claims.  DeltaCare specialists submit claim forms for DeltaCare patients.

DeltaCare Specialty Referral Form

This referral form is for DeltaCare primary dentists to use to refer a DeltaCare member to a DeltaCare specialty dentist. The DeltaCare specialty listing can be accessed through the Specialty Listing link above.