Dental Resources

  • For all providers who need to get credentialed or recredentialed with Premera, learn how to join our network. If you need to change your office information or add a provider to your clinic, fax us a provider update form.

    Helpful links for dental providers

    • Sign in to Availity to use secure online tools (select Premera Dental as a payer).
    • Dental reference manual: Get info on x-rays, anesthesia, and billing, plus a dental FAQ.
    • Dental documentation guidelines: Check out the most recent codes and dental terminology.
    • Dental ID card examples
    • Individual plans: The individual plan website is managed by Evolent Health for Premera and uses tools specifically for patients with individual plans. If a member has an individual plan, their ID card will say Individual Plan.
    • Medicare Advantage plans: The Medicare Advantage dental website is managed by Dominion National and uses different tools for patients with Medicare Advantage plans. Member ID cards are identified as Medicare Advantage.

    Claim payer IDs

    Claim payer IDs are used to make sure your electronic transaction is routed to the right health plan. If you're using a clearinghouse, be sure to verify all payer IDs as they might request that you use a different payer ID than those listed here.

    Plan Professional Dental
    Premera Blue Cross* 00430 47570

    *These payer IDs work for all Premera plans, including Medicare Advantage, FEP, BlueCard, and NASCO. View payer IDs for Individual Plans.

    Claims mailing address:
    PO Box 91059
    Seattle, WA 98111-9159

    Quick answers to common questions

    What is a predetermination?
    A dental pre-determination is used to verify a member’s benefits before services are started so financial arrangements can be made for reduced or uncovered services. Use the code check tool in Availity Essentials to see which procedure codes recommend a pre-determination.

    How do I submit a pre-determination or prior authorization request?
    There are three ways to submit a dental pre-determination request, just as you’d normally submit a claim through:

    For dental prior authorization for the following services, fax a dental prior authorization form to 425-918-5956.

    • Cosmetic and reconstruction services
    • General anesthesia and facility services related to dental treatment
    • Orthodontic services for treatment of congenital craniofacial anomalies
    • Orthognathic surgery
    • Temporomandibular joint disorder (TMJ)

    Can I email x-rays? No. We can’t accept emails from outside Premera with attachments. Digital x-rays must be faxed to us at 425-918-5956 or submitted to National Electronic Attachments (NEA) or Change Healthcare (CHC). Our payor ID is 47570. 

    Are 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 necessity and the diagnosis of obstructive sleep apnea. Snoring problems alone aren’t covered. A prior authorization is required; see the medical policy for more information.

    Does my dental contract include billing for medical services?
    Yes, under your dental contract you can bill for both dental and medical services. When billing for a medical service use a CMS 1500 form.

    When do I bill for medical instead of dental?
    For some procedures, the line between medical and dental isn’t always clear. We’ll review the submitted claim to determine if the service is payable under the medical or dental plan. If it’s a tooth- or gum-related tumor or cyst, it’s often payable under dental. If it’s a lip-, tongue-, or cheek-related procedure, it’s often payable under medical. Sending an operative or pathology report is helpful when we review these types of claims for benefits.

    Do you allow composite fillings on posterior teeth?
    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 our customer service to confirm or verify benefits online.

    2nd and 3rd molars refer to:

    • Permanent teeth: 1-2, 15-18, 31-32
    • Primary teeth: A, J, K, T

    View more frequently asked questions.

    Contact us

    For help with getting a copy of your fee schedule, changing your office tax ID, or notifying us of an ownership change, please email us. To complete your email request as quickly as possible, we do require the provider tax ID number, NPI numbers, and provider names for all emails. Please allow our team 20 to 30 days to complete your request.

    For further information on fee schedules, see our Dental Claims and Payments page.