November 19, 2020
The following are frequently asked questions and answers about dental care:
Can I email x-rays? No. We can’t accept external emails with attachments. Digital x-rays must be faxed to us or submitted to NEA (payor ID: 47570; fax: 425-918-5956).
What is 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. Use the code check tool to see which procedure codes recommend pre-determination.
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.
For more frequently asked questions, helpful dental links, and information about joining our dental network, visit our Dental resources page.
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