![]() If it’s a lip-, tongue-, or cheek-related procedure, it’s often payable under medical. If it’sĪ tooth- or gum-related tumor or cyst, it’s often payable under dental. We’ll review the submitted claim to determine if the service is payable under the medical or dental plan. When do I bill for medical instead of dental? For some procedures, the line between medical and dental isn’t always clear. When billing for a medical service use a CMS 1500 form. A prior authorization is required see the medical policy for more information.ĭoes my dental contract include billing for medical services? Yes, under your dental contract you can bill for both dental and medical services. Necessity and the diagnosis of obstructive sleep apnea. Use the code check tool in Availity to see which procedure codes recommend predetermination.Īre oral appliances covered? An oral appliance and oral appliance therapy can be reviewed for available medical plan benefits, but we require documentation of a sleep study, cardio-respiratory study, or polysomnography to verify medical What is predetermination? Use a dental pre-determination to verify a member’s benefits before services are started so financial arrangements can be made for reduced or uncovered services. Digital x-rays must be faxed to us at 42 or submitted to National Electronic Attachments (NEA) or Change Healthcare (CHC). We can’t accept emails from outside Premera with attachments. Seattle, WA 98111-9159 Quick answers to common questionsĬan I email x-rays? No. *These payer IDs work for all Premera plans, including Medicare Advantage, FEP, BlueCard, and NASCO. Use a different payer ID than those listed here. If you're using aĬlearinghouse, be sure to verify all payer IDs as they might request that you Member ID cards are identified as Medicare Advantage.Ĭlaim payer IDs are used to make sure your electronic transaction is routed to the right health plan. Medicare Advantage plans: The Medicare Advantage dental website is managed by Dominion National and uses different tools for patients with Medicare Advantage plans.If a member has an individual plan, their ID card will say Individual Plan. Individual plans: The individual plan website is managed by Evolent Health for Premera and uses tools specifically for patients with individual.Dental documentation guidelines: Check out the most recent codes and dental terminology.Dental reference manual: Get info on x-rays, anesthesia, and billing, plus a dental FAQ.Sign in to Availity to use secure online tools (select Premera Dental as a payer).To your clinic, fax us a provider update form. If you need to change your office information or add a provider ![]() You can click on the link to view the EOB.Ī Letter button displays when information has been requested for a claim and when clicked, a copy of the letter sent to the patient and provider displays.ĭue to HIPAA Privacy Regulations, members are not able to view claim information for a spouse or dependent children aged 18 and over unless the spouse or dependent has provided authorization.For all providers who need to get credentialed or recredentialed with Premera, learn how to join our network. ![]() If the claim is paid, an Eob button displays. The Download button creates a spreadsheet of the claims displayed on this page, not the Explanation of Benefits (EOB). To search for claims over 30 days old, enter the Advanced Search criteria for the claim and click Search. Claims for the past 30 days will automatically display. Call the number listed on your insurance card for assistance.įrom the menu options, select Claims and then Claim status. Note: For members enrolled in a Managed Dental Care (MDC) plan, dental claims are not viewable in Guardian Anytime. To view your dental claims status, follow these steps in Guardian Anytime. ![]()
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