Claims Submission and Utilization Review FAQs
How do I obtain claims status information or a copy of an Explanation of Payment (EOP)?
Contact our Customer Care Department at (800) 999-9789 to check the status of claims payments or to request a copy of the EOP.
Do you accept electronic claims submission?
Yes, we accept electronic claims submission. We currently work with:
- Apex – UTDSL
- UHIN – HT006329
- Tesia – DSL01
- Change Healthcare (Emdeon) – CX093
- DentalXchange – DSL01
Do you accept electronic attachments?
Yes, we accept electronic attachments from NEA, Tesia, and Change Healthcare
How do I submit electronic claims?
Your office will need to have a system that is linked to a clearinghouse with software or internet access. All electronic claims must be submitted through a clearinghouse. Include the following:
- Name of treating dentist
- Tax ID number
- Service treatment address
What is your fax number for claims submission?
What is your mailing address for claims submission?
Submit claims to the following address:
PO Box 851917
Richardson, TX 75085
Do you accept standard ADA claim forms?
Yes, we accept standard ADA forms.
What is our Utilization Review Program?
We have established a utilization review program to ensure that any guidelines are used consistently and include procedures for applying criteria based on the documentation submitted. The criteria was developed with involvement of dental consultants who are licensed dentists. The program is reviewed regularly to ensure the guidelines are current with dental technology, evidence-based research and any dental trends.
During the review of submitted procedures, there may be a determination by a qualified and appropriately licensed dentist that the procedure(s) do not meet the contractual limitations as outlined in the specific dental policy and/or coding as defined in the CDT book. When a claim has been denied or partially denied based on the contractual limitations of the dental policy and/or coding as defined in the CDT book, or an alternate benefit was recommended, the dentist is made aware in writing.
When should I submit x-rays, charting, and other supporting documentation?
Supporting documentation (including pre- and post- op x-rays, charting, detailed narratives, previous history and/or clinical notes) is commonly required and is not limited to fillings, crowns, bridges, dentures, implants, periodontal work, surgical extractions, oral surgery and some exams. Submitting supporting documentation with the claim will help avoid delays in claim payment. If missing or additional information is needed, a letter detailing the specifics will be mailed to the provider.
Who do I contact about a tax statement, withholding or B-notice?
Contact your Provider Relations Representative at firstname.lastname@example.org or Customer Care at 800-999-9789.
How can I find benefit information for a patient?
Eligibility and benefit information can be obtained by calling our Faxback system at 800-999-9789, option 2, or contacting our Customer Care department at 800-999-9789.
How often is the directory updated?
The directory is updated weekly.
Can members receive benefits from any provider or must they see a network provider?
A member always has a choice in selecting their own dental provider. However, by choosing a network provider, members may help manage their out-of-pocket costs.
Do you require pretreatment estimates?
We do not require pretreatment estimates but highly recommend they be requested since it is the best method for determining what will be paid and what the member will be expected to pay prior to treating the patient.
What happens when a member needs to see a Specialist?
The member can go to the Find a Provider section of the directory to select a network specialist or to find a list of network providers. You can also suggest a Network Specialist, but the member does not require approval to be seen by a Specialist. The member can also contact our Customer Care department at 800-999-9789.
Who do I contact about becoming a member of the Dental Select Network?
You can request an application by contacting our Customer Care department at 800-999-9789, find the Become a Provider section of our website, or by contacting email@example.com.
How will I know if I am a Network Provider?
Upon acceptance into the Dental Select network, you will receive a confirmation email from your Provider Relations Recruiter confirming your Network effective date.
How do I obtain a list of contract fees?
A list of contract fees can be obtained by contacting your Provider Relations Recruiter directly, by making a request to firstname.lastname@example.org, or by contacting our Customer Care dept. at 800-999-9789.