Provider Forms and Manuals

Producer forms and document

Download important documents and forms to help make selling Delta Dental easier for you.


To access and view the Ohio TriState Advantage Medicaid Provider Manual and the Ohio TriState Advantage Next Generation MyCare Provider Manual, please log in to the Dental Office Toolkit (DOT). The provider manuals will be located in the Administration section of DOT on the left side, under “Forms.”


Non-covered Services Form

Download a form for non-covered services.

Download

Medicare Advantage and Medicaid Claim Adjustment Form

Download a form for non-covered services.

Download

Claim adjustment request form (groups/commercial)

Download a form for claims adjustments.

Download

Medicaid and Next Generation MyCare Orthodontic Services Prior Authorization Form

Download