Forms

At Delta Dental, we want to make selling our products as simple as possible. We have made available for download important forms to ensure you have everything you need just a click away.

Delta Dental of New Mexico Enrollment/Coverage Status Form (paper version)

Delta Dental of New Mexico Enrollment/Coverage Status Form (electronic version)

Note: You can fill out most of this form on a computer. However, you will need to print it, sign it, and then return a paper or scanned copy to Delta Dental of New Mexico.

Small Group Application (Dental and Vision)

Large Group Application (Dental and Vision)

Employer Subgroup Information Page and Application Addendum

Individual Authorization Form

ACH Authorization

Claim Form

Dental Claim Form: To access a dental claim form, enrollees can log into Member Portal . They can also call Customer Service at (877) 395-9420 or send an email to customerservice@deltadentalnm.com to request a dental claim form.

Mail completed claims to:

Delta Dental of New Mexico

100 Sun Avenue NE, Suite 400

Albuquerque, NM 87109

If the information you are looking for is not available here, contact your Account Manager.

Forms

At Delta Dental, we want to make selling our products as simple as possible. We have made available for download important forms to ensure you have everything you need just a click away.

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