FAQs re: Dental Claims and Prior Approval
This list reflects answers to frequently asked questions (FAQs) regarding Dental Claims and Prior Approval.
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1. Do I have to enter a diagnosis code to file my claim or prior approval request?
No. Diagnosis codes are no longer a required field in submitting Dental claims or prior approvals (PA). This may not be apparent when using the Provider Portal, but if a diagnosis is included, it may cause a denial. When submitting a Dental claim or PA, providers should leave this field blank.
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2. How can I add Emdeon (or others) as a Billing Agent on my provider record?
Follow these Instructions to add Emdeon as Billing Agent. The same process can be followed to add other Billing Agents, simply by searching on the appropriate Billing Agent name in step 7 of the instructions.
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3. How do I send in x-rays and other information needed for my dental prior approval (PA) requests?
On the provider portal, there is a button in Prior Approval Entry where you can upload digital x-rays or ADA forms or whatever other information is needed, in a variety of different formats (PDF, JPEG, etc.). You can also opt to send via mail or fax: PA MAIL: CSRA P.O. Box 31188 Raleigh NC 27622-1188; Fax: Non-Pharmacy Prior Approval: 855-710-1964. Faster processing of Prior Approvals occurs if everything is submitted online via the portal.
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4. How do I send in orthodontic models?
You may submit your Prior Approval (PA) via the portal, but you may send the models the same way as before. However, PLEASE include the coversheet provided on the portal for your PA that has the appropriate patient information so we may link up the online PA to the models as they come in.
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5. Why am I seeing a few of my PAs voided?
We are finding that some providers are submitting duplicate Prior Approvals (PA) as they learn the system. We are voiding out the duplicates and working the appropriate one. Remember you may make adjustments online to your PA after you have submitted it.