Claims Processing Turnaround Time
The New Jersey
Prompt Pay Law requires that Delta Dental process "clean" claims
in 30 days if submitted electronically and 40 days
if submitted by paper.
to the New Jersey Administrative Code ("N.J.A.C."), Title 11, Chapter 22,
Section 1.2, a "clean" claim means:
- The claim is for a service or supply
covered by the health benefits plan or dental
- The claim is submitted with all
of the information requested by the carrier on
the claim form or in other instructions distributed
to the provider or covered person.
- The person to whom the service
or supply was provided was covered by the carrier's
health benefits or dental plan on the date of
- The carrier does not reasonably
believe that the claim has been submitted fraudulently.
- The claim does not require special
treatment. Special treatment means unusual claim processing
is required to determine whether a service or
supply is covered, such as claims involving experimental
treatments or newly approved medications. The
circumstances requiring special treatment should
be documented in the claim file.
Submit questions to:
Delta Dental of New Jersey, Inc.
1639 Route 10
Parsippany, NJ 07054