A "dental decision" is a decision which is based upon a dental diagnosis or dental judgment. If you have received an Explanation of Benefits or Pre-Treatment Estimate that reports a denial, reduction or failure to provide payment, in whole or in part, for a service based upon a "dental decision" AND (a) you are a New Jersey licensed dentist AND (b) you disagree with such determination, then you have the right to speak with a dentist at Delta Dental concerning the dental basis for the dental decision. As a precondition, you must submit a written and signed explanation of the basis for your disagreement within the time period for challenging the claim determination to Delta Dental, Attn: Adverse Determination Review, P.O. Box 617, Parsippany, NJ 07054. We urge you to include any documentation you want us to consider.