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Claim Tips & Guidelines

Resources to submit claims

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Electronic solutions for easy claim submission

Want to get paid faster?  Submit your claims electronically!  You should:

Review the Electronic Claim Vendor List Electronic Claim Vendor List
You can also submit paper claims. Claim FAQ

While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips

Print dental claim form (English)
Print dental claim form (Spanish)

How to submit attachments

Submit your attachments, such as X-rays, electronically using FastAttach® by National Electronic Attachment (NEA).

Our guidelines explain when we require attachments.
Claim documentation guidelines 
New attachment requirements for crown buildups-2950

 

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Explanation of Benefits (EOB)

EOBs have detailed claim payment information. Our sample EOB and key make them easy to understand.

Sample EOB
EOB Key

 

Policies that affect payments

Precertification and predetermination

We recommend pretreatment estimates for some services. They explain how much we will pay based on a member's benefits.

Check our precertification guidelines

Downcoding and bundling

We don't automatically change procedure codes or bundle claims for covered services. Any changes we make happen after a professional review.

Read these policies

Claim Administration Policies

Come here periodically to see updates on our claim handling.

Claim resources for specialists

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Orthodontic claim tips

Following our guidelines will speed up claim determinations.

See our guidelines 

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Oral surgery claims

If you have questions about oral surgery benefits, our dedicated team can help.

Find answers to common questions

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Salzmann evaluation form

This form helps determine if a patient qualifies for coverage of medically necessary orthodontic services.

Learn more about the Modified Salzmann Index

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