Submitting Medicare Advantage Dental Claims for Out-of-Network Providers

  • May 5, 2022

    If you provide dental services to a Premera Medicare Advantage (MA) member, but you’re not in our Medicare Advantage dental network, you have three ways to submit your claims to receive payment:

    1. Submit claims electronically. Visit our electronic transactions page for more information on how to send an electronic claim.

    2. Mail paper claims. Include the member ID number including the ZNP prefix and send to:
      Premera Blue Cross
      P.O. Box 91059
      Seattle, WA 98111-9159

    3. Collect payment from your patient and provide them with a completed ADA claim form or itemized statement. Then ask them to submit their claim for reimbursement by filling out the MA dental reimbursement form. Your patient can find the form on the Medicare Advantage member website.

    If you’re interested in becoming a Premera Blue Cross Medicare Advantage contracted provider, contact Provider Relations at and include your Tax Identification Number (TIN).

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