Peer-to-Peer Discussion

Treating dentists who need an explanation of the clinical rationale for the denial of a dental procedure based on an adverse medical necessity or clinical appropriateness determination may request up to a half-hour peer-to-peer discussion with one of our dental consultants. Peer-to-peer discussions are not available for claim denials based on an exclusion, limitation, benefit exhaustion or other contractual provision of a patient's dental plan which does not require a medical necessity or clinical appropriateness determination. To request a peer-to-peer discussion, please download the form from the link, and save it to your desktop. You can then open the form from your desktop, fill it out, and save the completed form. E-mail the completed form to peertopeer@deltadentalmi.com, fax the form to 000-000-0000 or mail it to:

Peer-To-Peer Discussion Request
Delta Dental
PO Box 0000
Farmington Hills, MI 48333-9085

Upon receipt of your request, we'll reach out to you within 5 business days to schedule your peer-to-peer discussion. Please be prepared to provide at least two callback times
during the business hours of 9 a.m. to 3 p.m. Eastern Standard Time. A peer-to-peer discussion may be requested on behalf of a treating dentist by dental office staff, however the treating dentist must sign the request form and the peer-to- peer discussion must be conducted directly with the treating dentist.

Dentists not directly involved in providing the denied procedure(s) may not request or conduct the peer-to-peer discussion. A peer-to-peer discussion is not an appeal and will not result in a change in the initial denial of a dental procedure unless new information is presented that supports the medical necessity or clinical appropriateness of the denied procedure. Peer-to-peer
discussions are not available if an appeal of a denial has been submitted.

Michigan Healthy Kids Dental Providers

Please note that you must first submit a provider appeal of a denied dental procedure to Delta Dental before requesting a peer-to-peer discussion. Refer to your Healthy Kids Dental Program Office Guide section on grievances and appeals for more information on the provider appeal process.

Delta Dental of Minnesota Providers

Delta Dental requires providers to use a "resubmission" request by selecting that option on a Provider Inquiry Form to resubmit claims for clerical corrections, or to provide additional information to support the original claim submitted. Provider disputes will only be processed as a dispute if the provider has first attempted to resubmit the claim for correction or additional review prior to the dispute being filed.