FAQs re: Dental Claims and Prior Approval

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.

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.

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.

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.

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.