What is a missing tooth clause?
Services pertaining to tooth loss prior to the start of the member’s coverage with our dental plan are not included.
What is a non-duplicate policy?
Coordination of benefits refers to the avoidance of duplication. Our payment is synchronized with the primary plan’s payment. If the primary payment is equal to or greater than our primary payment, we will not make any secondary payment. For instance, if the other coverage pays $60.00 for a filling (D2140) and the allowed amount is $60.00, we will not pay anything. Similarly, if the other carrier pays $45.00 and the allowed amount is $65.00 for a perio-cleaning (D4910), and the dentist charges $70.00, we will pay $20.00 ($65.00-$45.00=$20.00).
Is there a designated Provider Advocate for dental services?
There is no Advocate Provider who works specifically with dental providers only. The Advocate Provider, who is located in your county, can be contacted according to the county where your office is located.
How are supernumerary teeth indicated on the patient’s tooth chart in My Insurance Manager?
If you have any questions related to benefits for a member’s dental services involving supernumerary teeth, please contact the appropriate service center. Add the letter “S” to the corresponding primary tooth in the primary dentition for a supernumerary tooth. When reporting services rendered on teeth supernumerary in the permanent dentition, refer to the chart below for the standard numbering scheme. The likelihood of someone having supernumerary teeth is rare, with less than 20 percent of the population. Therefore, teeth supernumerary are not indicated on the tooth chart in My Insurance ManagerSM.
When filing claims for a Federal Employee Program (FEP) BlueDental member on an ADA claim form, should it go to BlueCross FEP Medical first?
Initially, FEP BlueDental will dispatch the subsequent payment to you. After coordinating the benefits, the primary advantage will be synchronized with the claim received from the healthcare carrier. FEP Medical will transmit the claim, together with the primary payment sum, to FEP BlueDental, and subsequently, the primary payment will be dispatched to you. Make sure to submit all claims to the member’s primary healthcare plan initially, correct?
Is the submission of a pre-treatment estimate similar to a prior authorization request?
An estimate for pre-treatment services is recommended but not required for a dental Commercial Authorization request. It is considered prior to the pre-treatment processes, and the payable benefits at the time of treatment are a real-time snapshot of the benefits.
Are there waiting periods applied to certain services?
Depending on the group’s benefits, certain plans may impose waiting periods of 6-12 months for both basic and major services, whereas other plans may not require any waiting period. This is determined by the specific dental plans offered by some commercial providers.