Brokers already appointed with Delta Dental may self-register for the Broker Connection by completing the registration process below.
WEBSITE USE AGREEMENT
This DELTA DENTAL OF WISCONSIN Website Agent Connection Security Form and User Agreement (the “Agreement”) is entered into, as of the date of the signature below, between Delta Dental of Wisconsin Inc. (referred to as “DELTA DENTAL OF WISCONSIN”), and the agency identified in the Agency Information section.
DELTA DENTAL OF WISCONSIN appoints the persons identified in the Agent Information section (the “Authorized Users”), as nonexclusive users of the DELTA DENTAL OF WISCONSIN Information System (the “System”). Each Authorized User is authorized to access the designated DELTA DENTAL OF WISCONSIN website, by means of a secure user ID and password, to view and receive information from the Agent area of the website for only those agents associated with the agency named above.
The Agency agrees to notify DELTA DENTAL OF WISCONSIN within 10 days, and complete a new Agreement, if the Agency Principal is no longer with the agency or is no longer the primary contact person for the Agency.
The Agency Principal is responsible for notifying DELTA DENTAL OF WISCONSIN of any additions, deletions or other changes to the list of Authorized Users.
This Agreement may not be modified or changed orally. All modifications must be in writing and signed by DELTA DENTAL OF WISCONSIN and the Agency Principal.
The System contains sensitive, confidential, and proprietary health benefit plan and financial information and must be protected against unauthorized disclosure, release, modification or other action. By entering into this Agreement, the Authorized Users agree to treat information as confidential and to preserve its confidentially in accordance with all applicable state and federal laws and with DELTA DENTAL OF WISCONSIN’s rules and procedures for the users of the System. The Authorized Users also understand and agree that information is subject to change, information does change, and that DELTA DENTAL OF WISCONSIN relies on information provided by other sources not within DELTA DENTAL OF WISCONSIN’s control. As a result, DELTA DENTAL OF WISCONSIN makes no warranty or guarantee concerning the accuracy or reliability of the information accessible on the DELTA DENTAL OF WISCONSIN website or on any other websites to which the DELTA DENTAL OF WISCONSIN website is linked.
The Authorized Users understand and agree that information obtained from the System does not guarantee payment of benefits by DELTA DENTAL OF WISCONSIN, or that any treatment, service, or supply provided to any patient is covered by DELTA DENTAL OF WISCONSIN. The Authorized Users further understand and agree that DELTA DENTAL OF WISCONSIN’s claim processing decisions about payment can only be made by DELTA DENTAL OF WISCONSIN when all necessary claim information is received and reviewed by DELTA DENTAL OF WISCONSIN in accordance with all terms, conditions, and provisions, including, but not limited to, exclusions of the applicable benefit plans.
The Agency shall defend, indemnify and hold DELTA DENTAL OF WISCONSIN and its employees, officers and directors harmless from all losses, claims, demands, damages, liabilities, or expenses, including attorneys’ fees and expenses, resulting from violation of this Agreement due in whole or in part to acts of any Authorized User or Agency Principal.
By executing this Agreement below, the Authorized Users agree to all terms and conditions of this Agreement. If these terms and conditions are violated, DELTA DENTAL OF WISCONSIN may revoke the access to rights of any Authorized User, without advance notice.
By executing this Agreement below, the Agency Principal represents that he/she has authority to act on behalf of the Agency and agrees to the terms above.