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Delta Dental Premier
Delta Dental Premier is the traditional fee-for-service plan with comprehensive and flexible dental benefit packages. Members may choose to go to any licensed dentist, but receive the highest benefit by seeing a Delta Dental Premier dentist. To apply for Delta Dental Premier participation, please complete the following:
- Participating Dentist Agreement Summary Disclosure Form click here
- Delta Dental Premier Participating Dentist Agreement (completed and signed) click here
- Substitute Form W-9 (completed and signed) click here
- Provider Credentialing Form (completed and signed) click here
- Also submit legible copies of the following:
- Colorado Dental License
- Dental Diploma
- D.E.A. Registration
- Current Malpractice Insurance Declaration Page
- Basic Life Support Certification
- Specialty Certification, if applicable
- National Provider Identifier (NPI) Official Notification
For reimbursement information regarding Two-Way Pricing and Delta Dental's Maximum Plan Allowance (MPA) click here
Participation in the Delta Dental Premier network is required for participation in any other Delta Dental network and/or program.
Delta Dental PPO
Members may choose any licensed dentist for treatment under the Delta Dental PPO plan, but they receive their highest level of benefits if they choose a Delta Dental PPO dentist. PPO dentists have agreed to accept the PPO Schedule of Allowances as payment in full for services.
To apply for Delta Dental PPO participation, submit all of the documents required for Delta Dental Premier participation plus the Delta Dental PPO Participating Dentist Agreement.
Currently a Delta Dental Premier provider? Delta Dental Premier dentists who want to join the PPO program must submit a completed Delta Dental PPO Participating Dentist Agreement, along with updated copies of the additional documents listed below:
- Participating Dentist Agreement Summary Disclosure Form click here
- Delta Dental PPO Participating Dentist Agreement (completed and signed) click here
- Substitute Form W-9 (completed and signed) click here
- Provider Credentialing Form (completed and signed) click here
- Also submit legible copies of the following:
- D.E.A. Registration
- Current Malpractice Insurance Declaration Page
- Basic Life Support Certification
- Specialty Certification, if applicable
- National Provider Identifier (NPI) Official Notification, if NPI has been obtained
For the Delta Dental PPO Schedule of Allowances  Log on here
Child Health Plan Plus (CHP+)
If you are a Delta Dental Premier dentist and agree to accept PPO fees for only the CHP+ program (and do not wish to join the
PPO network), complete the CHP+ Agreement.
If you are not a Delta Dental Premier or PPO dentist and wish to be part of the CHP+ dentist network, please complete the following:
- Delta Dental CHP+ Participating Dentist Agreement (completed and signed) click here
- Substitute Form W-9 (completed and signed) click here
- Provider Credentialing Form (completed and signed) click here
- Also, submit legible copies of the following:
1. Colorado Dental License
2. Dental Diploma
3. D.E.A. Registration
4. Current Malpractice Insurance Declaration Page
5. Basic Life Support Certification
6. Specialty Certification, if applicable
7. National Provider Identifier (NPI) Official Notification
- CHP+ Information and Plan Allowances Log on here
- If you cannot access the CPSA secure site and would like more information, contact us at ProfServices677@ddpco.com or 303-889-8677 or 800-233-0860 x677.
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