Appeals & Grievances
Use one of our secure forms below to file a grievance or appeal a dental benefits decision.
If you are a current Member, you may use the form below to appeal an Adverse Determination or Administrative Decision made by Delta Dental of New Mexico.
You and your Dental Provider may use this form when requesting an Expedited Appeal of an Adverse Determination made by Delta Dental of New Mexico.
Fill Out Provider Certification for Expedited Adverse Determination Appeal Form
A Dental Provider may use this form to ask Delta Dental of New Mexico to review a concern about a decision or practice. No person shall be subject to retaliatory action by Delta Dental of New Mexico for submitting or supporting an Appeal.