To complete your email request as quickly as possible, we do Contact usįor help with getting a copy of your fee schedule, changing your office tax ID, or notifying us of an ownership change, please email us. Our customer service to confirm or verify benefits online. Many of our dental plans consider posterior composite fillings on 2nd or 3rd molars as cosmetic and will be reduced to the corresponding amalgam allowance, but this can vary – contact Sending an operative or pathology report is helpful when we review these types of claimsĭo you allow composite fillings on posterior teeth? 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?įor some procedures, the line between medical and dental isn’t always clear. When billing for a medical service use a CMS 1500 form. Yes, under your dental contract you can bill for both dental and medical services. A prior authorization is required see the medical policy for more information.ĭoes my dental contract include billing for medical services? Necessity and the diagnosis of obstructive sleep apnea. Our payor ID is 47570.Īn 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 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. Services for treatment of congenital craniofacial anomaliesĬan I email x-rays? No. Submit a dental pre-determination request as you’d normally submit a claim through electronic data interchange (EDI), or byĭental prior authorization for the following services, fax a dental prior authorization form to 42.Īnesthesia and facility services related to dental treatment How do I submit a pre-determination or prior authorization request? Use the code check tool in Availity to see which procedure codes recommend pre-determination. 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. Seattle, WA 98111-9159 Quick answers to common questions *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 For all providers who need to get credentialed or recredentialed with Premera, learn how to join our network.
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