Delta Dental of Arkansas fax number

Fax destination details

Department

Claims Department

Purpose

Submitting dental claims. Claims can be faxed to the Delta Dental of Arkansas claims fax number (800-500-8991) or mailed to the Claims Department at PO Box 15965, Little Rock, AR 72231.

Form

ADA Dental Claim Form (J43024) — ADA Dental Claim Form

Address

Delta Dental of Arkansas, Attn: Claims Department, PO Box 15965, Little Rock, AR 72231

Voice phone

(800) 462-5410

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete sections 1-17 of the claim form. If applicable, the dentist should fill remaining sections. All claims must be submitted within 12 months of the date of service. Send the completed form to Delta Dental of Arkansas, Attn: Claims Department, PO Box 15965, Little Rock, AR 72231, or fax to 800-500-8991.

Official form instructions are published as a downloadable file on the organization's website.