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.
Can I email x-rays? No. We can’t accept emails from outside Premera with attachments. Digital x-rays must be faxed to us or submitted to NEA (payor ID: 47570; fax: 425-918-5956).
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. Use the code check tool to see which procedure codes recommend predetermination.
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:
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For help with getting a copy of your fee schedule, to change your office tax ID, or to notify us of an ownership change, call our Provider Relations team at 877-342-2528 option 4 or email us at email@example.com.
For further information on fee schedules, see our Dental Claims and Payments page.