Dental claims submissions

Claims must be submitted electronically. Please ensure you use the correct payor ID and that your claims submission information, including NPI for the rendering provider and the billing practice, rendering address, and billing address, are accurate in your electronic health record systems and with your clearinghouse. For other contact information and mailing addresses, please contact us.

If you are experiencing issues with electronic claims rejections, you will receive a 999 Functional Group Acknowledgement Report identifying the issue. A dental claim will reject upfront if the electronic format does not pass Strategic National Implementation Process (SNIP 5) validation. Please do not submit data that is duplicate or does not meet ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 guidelines. Contact your software vendor or direct clearinghouse for assistance to the necessary corrections. 

Some common items that will cause claims rejections:

• 2010BB & 2310B: Sending a billing and/or rendering secondary identification in the REF*LU in loops. Only submit the billing Tax Id number and NPI in the billing section, and provider NPI in the rendering provider section, do not include any other secondary identification numbers.
•  SV306 Service Quantity: The SV306 field is only required when the procedure was performed more than once and must be a value greater than 1. The default is 01, only load a number greater than 01 when a procedure is delivered to the patient more than once on the same date of service.
• Sending duplicate date of service at line level when it’s the same at claim level. Avoid submitting duplicate services on claims.
• Sending duplicate NPI in Service Facility Location when it’s the same as the billing loop NPI. If a provider uses his Type 1 NPI for billing, only populate the NPI in the billing section. 
• N403 ZIP code format is incorrect: Use expected value from U.S.P.S. when country is the U.S.  
• N301 address format is incorrect: Expected value should be the physical location for the rendering provider. 'PO BOX' or 'P.O. BOX' should not be used.
•  Loop 2010AA, Segment REF indicates (Billing Provider UPIN/License Information) is populated. Only include the billing NPI. Do not use the billing provider UPIN/License information.