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DPAP 201

Dental Claim Submission Number Requirements


Provider Administrative Policy

Section
Claims Submission
Policy Date
January 2012
Status/Date
Revised/May 2013
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Dental Claim Submission Number Requirements

Submit hard copy claims on an American Dental Association (ADA) claim form with billing and treating provider numbers.  We will return all claims that don’t have provider numbers.

The Health Insurance Portability and Accountability Act (HIPAA) mandates all providers must have a National Provider Identifier (NPI) for all electronic transactions. Electronic claims without NPI numbers will "error" and require correction and resubmission before the system can process them for payment.

Billing Number
The billing number indicates who should be paid and is the same as the treating provider number if the provider operates a solo practice (only one provider in a practice), or the number assigned to a clinic (a practice with more than one provider under one tax identification number) if the provider is in a group practice. The organizational NPI number goes in item 49. If using the Blue Cross of Idaho legacy billing number, it goes in item 52A when submitting hard copy claims.

Treating Number
The treating number is for the individual rendering the service. The individual NPI number goes in item 54 when submitting hard copy claims.  If you belong to a clinic, your treating number is different from the billing number.

All services must be billed by the provider who is performing the service.

If different providers within a clinic perform services, please submit a separate claim for each provider of service. To ensure correct and timely processing of your claims, item 56 on the ADA claim form must include the location of where you render the services. Claims missing this information may experience processing delays or cause payments to go to the incorrect service location.

Blue Cross of Idaho will not recognize the patient account information identified in item 23 when submitted via hard copy on the  ADA claim form.


Policy History

Date Action Reason
May 2013 Revised Added - All services must be billed by the provider who is performing the service.
December 2012 Revised Removed exceptions to patient account information. Removed 2006 for ADA claim form.