Dental Claims

Asuris Northwest Health prefers dental claims to be submitted electronically or by using the current American Dental Association (ADA) standard claim form, with the most current version of ADA's CDT code.

Claims Submission Tools and Tips

• View descriptions of commonly encountered dental Message Codes (PDF) .
  

X-rays

Effective May 1, 2007 Asuris Northwest Health will no longer return x-rays to your office. 

The ADA CDT 2007-2008 (current dental terminology) states that radiographs  “Should be taken only for clinical reasons as determined by the patient’s dentist. Should be of diagnostic quality and properly identified and dated. Is a part of the patient’s clinical record and the original images should be retained by the dentist. Originals should not be used to fulfill requests make by the patients or third-parties for copies of records.”  

In order to expedite processing of claims, please send only duplicate x-rays for the following:

• Multiple anterior crowns (two or more on same date of service or on pre-treatment courtesy review)
• Veneers
• Implants (full mouth x-rays or panorex)
  

• Debridement vs. difficult prophy:

• Code debridement (D4355) when no prophy or root planing has been done within 3 years and no other treatment is performed on the same day (excluding an exam or x-rays).
• No ADA code exists for a difficult prophy. Submit for a regular prophy (D1110) with your regular charge and submit the balance with a miscellaneous code of D9999. The additional charge will be the patient’s responsibility.
  
  NOTE: Asuris Northwest Health may make a request for a x-ray or perio charting after a claim has been processed.

• Claims not utilizing current CDT procedure codes will be denied for the correct procedure code. The message code of NC8 will be indicated on your payment voucher. The claim can be corrected by simply calling our dental analysts’ and providing the correct code.
• Access is available through the Internet for dental providers to research the status of patient claims, eligibility, benefits and amounts remaining of their annual maximum. To register, visit OneHealthPort and follow the directions to assign your office a password.

Please call your dental relations representative with any questions regarding the above.

Predetermination of Dental Benefits

Asuris Northwest Health is pleased to offer,but does not require, a pre-service benefit determination for treatment plans. This service permits the patient and dentist an understanding of benefit coverage prior to beginning treatment. Predetermination of dental benefits, however, is not a guarantee of payment, and should any claim(s) for prior treatment be paid in the interim, estimated payments would be reduced. Actual benefits payable will depend upon the following:

• Patient and dental professional eligibility.
• Dentist participating status.
• Contract limitations.
• Benefits available.
• Benefit maximums in effect when the services are completed.
• Benefits may have been predetermined under the assumption that the patient is only insured under one policy. If the patient is insured under more than one policy, actual benefits payable may be adjusted due to coordination of benefits or maintenance (non-duplication) of benefits.

Please do not make requests if the cost of services is less than $300.00. If the amount it greater than $300.00, please send requests for pre-service benefit determination to:

Asuris Northwest Health
P.O. Box 21267
Seattle, WA 98111-3267