Claim Tips & Guidelines
Resources to submit claims
Electronic solutions for easy claim submission
Want to get paid faster? Submit your claims electronically! You should:
Review the Electronic Claim Vendor List Electronic Claim Vendor List
You can also submit paper claims. Claim FAQ
While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips
Print dental claim form (English)
Print dental claim form (Spanish)
How to submit attachments
Submit your attachments, such as X-rays, electronically using FastAttach® by National Electronic Attachment (NEA).
Our guidelines explain when we require attachments.
Claim documentation guidelines
Explanation of Benefits (EOB)
EOBs have detailed claim payment information. Our sample EOB and key make them easy to understand.
Policies that affect payments
Precertification and predetermination
We recommend pretreatment estimates for some services. They explain how much we will pay based on a member's benefits.
Downcoding and bundling
We don't automatically change procedure codes or bundle claims for covered services. Any changes we make happen after a professional review.
Claim resources for specialists
Orthodontic claim tips
Following our guidelines will speed up claim determinations.
Oral surgery claims
If you have questions about oral surgery benefits, our dedicated team can help.
Salzmann evaluation form
This form helps determine if a patient qualifies for coverage of medically necessary orthodontic services.