Get Mn Delta Dental Confidential Filed Fee Schedule 2014-2025

This guide will provide you with clear, step-by-step instructions on how to fill out the MN Delta Dental Confidential Filed Fee Schedule online. It is designed to assist users at all levels of experience in completing the form accurately and efficiently.

Follow the steps to successfully complete the MN Delta Dental Confidential Filed Fee Schedule.

1. Click the ‘Get Form’ button to access the MN Delta Dental Confidential Filed Fee Schedule and open it in your preferred editing tool.
2. In the License # field, enter your professional license number to verify your credentials.
3. Fill in your name in the designated area to identify yourself as the provider submitting the fee schedule.
4. Indicate the effective date of the fee schedule. Make sure this date is accurate, as the fees must be filed with Delta Dental 30 days prior to their effective date.
5. Complete the Operator field, entering the name of the operator responsible for this schedule.
6. In the Notes section, you can write any additional information or comments related to your fee schedule.
7. Review the Statement of Intent. Check the box indicating your agreement to comply with the terms regarding the fees submitted.
8. Provide your personal signature along with your printed name where indicated to confirm your submission.
9. Enter the tax identification and NPI number for your practice in the respective fields to ensure proper identification.
10. For each dental procedure, fill in the corresponding fee in the designated fields on the fee schedule. Ensure that the fees comply with the guidelines outlined in the document.
11. After filling out all required fields, save your changes. You may then choose to download, print, or share the completed fee schedule as needed.

Complete the MN Delta Dental Confidential Filed Fee Schedule online for a smooth submission process.