Dental Networks SPEED GUIDE - Blue Cross and Blue Shield of

®
Dental Networks
SPEED GUIDE
®
Blue Cross and Blue Shield of Louisiana members with dental benefits access one of three dental networks. Use
this guide to locate information quickly. Additional information is available in your Dental Network Office Manual.
Blue Cross Dental Network
The Blue Cross Dental Network is available to members with grandfathered, large group, self-insured group, and group standalone policies have access to the Blue Cross Dental Network. Benefits, authorizations and claims are handled directly by Blue
Cross. For full information on the requirements for authorizations, filing claims and more, the Dental Network Office Manual is
available online at www.bcbsla.com/providers >Education on Demand >Manuals.
Dental Claims
Reimbursement
• Use the ADA-Dental Claim Form: It is extremely important that you
Allowable Charges – Blue Cross
reimburses Blue Cross Dental Network
dentists based on allowable charges. The
allowable charge is the maximum amount
allowed by Blue Cross for covered dental
services.
complete all applicable information in full to facilitate prompt and accurate
claims payments.
• Enter your NPI in Block 49–NPI: The billing dentist’s National Provider
Identifier (NPI) is necessary for accurate claims processing.
• Use valid Current Dental Terminology® (CDT) code(s): Blue Cross cannot
accept unspecified codes. Please use the CDT code that most closely
matches the description of the service rendered.
Important Notes:
• When using code D9630, “Other drugs and/or medicaments, by report,”
please indicate the name of the medication in the “Description of Service”
area.
•
If Current Procedural Terminology® (CPT®) codes are used for a non-surgical
procedure, the codes will be rejected and returned for the proper CDT code.
Blue Cross Dental Network dentists agree
to accept the Blue Cross payment, plus
the member’s deductible, coinsurance
and/or copayment, if applicable, as
payment in full for covered services. In
return you receive prompt and direct
payment from Blue Cross as well as
marketing in our provider directory.
Oral Surgery Claims
Oral surgeons may bill either CPT or CDT codes for major oral surgical procedures but cannot be filed together on the same claim
form. CPT codes must be billed on the CMS-1500 claim form. If CPT codes are billed on an ADA Dental Claim Form, the claim will be
returned for the appropriate claim form. Oral surgeons may also bill for medical Evaluation and Management (E&M) services only when
associated with major oral surgical procedures as appropriate. Claims for these services must be filed on a CMS-1500 claim form.
•
•
•
Appropriate CDT codes must be billed when performing
extractions. If CPT codes are submitted for extractions, the
claim will be returned for appropriate CDT code(s).
All services related to impacted teeth must be filed with
diagnosis code 520.6. This includes all surgical and nonsurgical procedures.
Claims filed for office visits and x-rays with diagnosis code
524.3, but without a primary procedure code, must have a
brief description of services (Block 30 of the ADA form). If
there is no description, the claim will be rejected.
•
•
Do not file CPT code 41899 for surgical services, such as
extractions. Any claim filed with CPT code 41899 will be
returned for the appropriate CDT code.
CPT codes 21248 and 21249 are described as single
reconstructive procedures that do not allow for the
billing of multiple units based on the number of implants
placed. However, when billed with modifier 22, additional
reimbursement will be considered when documentation
with the number of implants is submitted.
Support
iLinkBLUE Provider SuiteElectronic Funds Transfer (EFT)
www.bcbsla.com/ilinkblue/
www.bcbsla.com/providers >Electronic Services
Customer Service
Call the number on the member’s ID card
Provider Service’s Voice Response Telephone System
1.800.922.8866
Filing Claims
iLinkBLUE, Clearinghouse or PO Box 98029, BR, LA 70898
To Join the Blue Cross Dental Network
1.800.716.2299, option 3
23XX4294 R02/14
CDT Only © 2014 American Dental Association CPT Only © 2014 American Medical Association
Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company
Last reviewed on February 7, 2014.
FEP Preferred Dental Network
The FEP Preferred Dental Network provides dental services for Federal Employee Program (FEP) members. FEP members are
easily identified by their ID cards. The member identification number will always begin with “R.” Similar to the Blue Cross Dental
Network, the FEP Preferred Dental Network offers fee-for-service reimbursement, direct payment and inclusion in our directories.
Reimbursement
Dentist in the FEP Preferred Dental Network agree to accept the FEP Maximum Allowable Charge (MAC),which includes Blue
Cross payment and member liability, as payment in full for covered dental services. Refer to the reimbursement section of the
Dental Network Office Manual is available online at www.bcbsla.com/providers >Education on Demand >Manuals for more
information on FEP dental reimbursement.
Dental & Oral Surgery Claims
Claims-filing requirements for FEP Preferred Dental Network claims follow the same guidelines outlined in the Dental Network
Office Manual, and on the front of this speed guide for the Blue Cross Dental Network.
Support
iLinkBLUE Provider SuiteElectronic Funds Transfer (EFT)
www.bcbsla.com/ilinkblue/
www.bcbsla.com/providers >Electronic Services
FEP Dedicated Customer Service
1.800.272.3029
Provider Service’s Voice Response Telephone System
1.800.922.8866
Filing Claims
iLinkBLUE, Clearinghouse or PO Box 98028, BR, LA 70898
To Join the FEP Preferred Dental Network
1.800.716.2299, option 3
Advantage Plus Dental Network
We offer dental benefit policies for purchase in the Healthcare Marketplace to individual members as well as members with nongrandfathered, small and stand-alone group policies. These dental products utilize the Advantage Plus Dental Network, which is
administered for Blue Cross by United Concordia Dental (UCD).
Groups may opt for the Advantage Plus Dental Network upon their renewal date. To be apart of the Advantage Plus Dental Network
and in-network for members with these benefits, providers must be contracted directly with United Concordia Dental. A Blue
Cross-dedicated customer service unit for benefits, authorizations and claims are all administered for Blue Cross by United
Concordia Dental.
To become an Advantage Plus Dental Network provider, you must be contracted with United Concordia Dental. For more
information contact UCD direct at 1.800.291.7920, ext. 9.
Reimbursement
Dentist in Advantage Plus Dental Network agree to accept United Concordia’s allowables. Refer to your United Concordia contract
for full reimbursement information.
Dental & Oral Surgery Claims
Claims-filing requirements for Advatange Plus Network claims are governed by United Concordia Dental.
Support
Blue Cross Dedicated Provider Services
To Join the Advantage Plus Dental Network
1.866.445.5825
1.800.291.7920, ext. 2 or ext. 8
Filing Claims
UCD Claims Administrator, PO Box 69441, Harrisburg, PA 17106-9441
A copy of our updated Dental Manual is available online at www.bcbsla.com/providers
>Education on Demand >Manuals and on iLinkBLUE (www.bcbsla.com/ilinkblue/) under
Manuals on the menu bar.

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