Frequently Asked Questions
- Working With Us
- Claim Processing
- Diagnostic Services
- Basic Services
- Major Services
Working With Us
Does it cost anything to join?
No, there is no charge to participate in the DNoA Preferred Network.
How will patients know I participate with DNoA?
Our Customer Service Dept can make active referrals to your office. Members also have access to our online and printed directories.
Where do I send claims?
Please refer to the back of the member ID card for the claim address and phone number for assistance.
I need a copy of my Administrative Guide. How do I obtain one?
Please call us at 800-972-7565 and we will be happy to send you a new copy.
Can I add an associate to my practice?
Yes, new associates can be added to your practice. The associate will need to complete the necessary paperwork and fax or mail the documents to DNoA for processing.
I need a copy of my fee schedule. How do I get one?
Please contact us directly at 800-972-7565 and we will be happy to provide you with copies of your contract and fee schedule.
Are Pre-authorizations required?
They are not required; however, they are suggested for services over $300.
How long is a pre-authorization valid?
They are valid through the end of the benefit period or when the policy changes, whichever comes first.
Will the x-rays I submitted with a claim be returned?
No. We advise you send us a duplicate or copies of current/dated images that are of diagnostic quality. All images must be of diagnostic quality, labeled including L or R as applicable and contain appropriate landmarks views.
Is there a missing tooth provision?
Use the Procedure Code Lookup field and search for procedure codes that are used to replace a missing tooth.
If there is a missing tooth provision on the policy, the message missing tooth provision is displayed in the Other Limitations field.
What is the payor identification number?
Payor identification numbers are specific to the clearing house you use. Please contact your clearing house with questions regarding payor identification numbers. The most commonly used payor ID codes are as follows:
Do you accept assignment of benefits?
For BCBSMT: We do not accept assignment. We make payment to the provider.
For BCBSIL, BCBSNM, BCBSOK, BCBSTX, and Dearborn National: We accept assignment. We make the payment to the payee designated on the claim submission.
Do you accept signature on file?
For BCBSMT: We do not accept signature on file. We make payment to the provider.
For BCBSIL, BCBSNM, BCBSOK, BCBSTX, and Dearborn National: We accept signature on file. We make the payment to the payee designated on the claim submission.
Do you accept electronic claims and electronic attachments?
We accept electronic claims; however, electronic attachments must be submitted through National Electronic Attachment (NEA).
If a bitewing image and a panoramic
image are taken on the same day, will it convert to a Complete Series (D0210)?
No. Our policy is to process the claim as submitted; however, claim payments may be limited to patient eligibility and frequency limitations according to a member’s benefit plan.
How many images make up a Complete Series (D0210)?
A Complete Series (D0210) usually consists of 14-22 images.
Are composite resin fillings covered on all teeth?
Yes. Composite resin fillings are a covered benefit on all teeth; however, alternate benefit provisions may apply. Check the Claim Processing Guidelines for tooth numbers where alternate benefit provisions may apply.
What codes are valid for periodontal history?
D4210, D4211, D4240, D4241, D4260, D4261, D4341, D4342 (D4342 only qualifies if performed on two or more quadrants.)
What time frame is required between periodontal therapy and periodontal maintenance (D4910)?
Since each patient’s periodontal condition is unique, there is a reasonable period required to allow for re-evaluation following periodontal therapy – generally, 4-6 weeks before initiating maintenance treatment.
Do you allow periodontal scaling and root planing (D4342) to be performed on all four quadrants on the same day?
Full mouth periodontal scaling and root planing can be performed on the same day when clinically appropriate and necessary.
What time frame is required between periodontal therapy and D4381?
The D4381 is not generally a covered benefit except in well documented refractory cases where an isolated tooth or limited teeth are involved. Re-evaluation following periodontal therapy must be well documented. (A period of at least 4-6 weeks elapsed following active periodontal therapy.)
Are benefits paid for D4381 by site or by tooth?
D4381 is a per tooth code which is based on the CDT descriptor.
Do you cover Full Mouth Debridement (D4355)?
Full Mouth Debridement is covered, subject to contract limitations. Full Mouth Debridement is not to be completed on the same day as a comprehensive evaluation.
Do you cover Scaling in the Presence of Generalized Inflammation (D4346)?
Scaling in the Presence of Generalized Inflammation is covered, subject to contract limitations, and should not be reported in conjunction with routine cleanings, scaling and root planning, or full mouth debridement.
Are bone grafts covered?
Bone grafts may be a covered benefit in instances where the graft is placed for certain clinical conditions and submitted with supporting documentations, i.e. 3 wall bony defects or implant placement.
Do you pay on prep or seat date?
We pay on seat date; however, certain employer groups may have exceptions to this rule and pay on prep date.
Are crowns subject to an alternate benefit?
Use the Procedure Code Lookup field and search for a code associated with a crown. Crown, bridge, and other prosthodontic procedures may be subject to Alternate Benefit Plan provisions. Also, procedures may be subject to Professional Review.
Do you cover treatment in progress?
Yes. Please submit the full treatment plan including the down payment amount, banding date, and total number of treatment months. We will prorate based on the effective date of our policy.
Is Invisalign® covered under orthodontia?
Yes. It is covered under orthodontia for eligible patients.
How are records covered for orthodontia?
If preventive or diagnostic procedures for orthodontic records are performed on an eligible patient, then these services are processed under the orthodontia benefit. They do not count against the preventive frequencies.
How do you cover the down payment for orthodontia?
The down payment for orthodontia is covered at the same percentage as other orthodontic services for eligible patients.
Is Do-It-Yourself treatment covered under orthodontia?
Do-It-Yourself (DIY) orthodontic treatments are not a covered benefit. Our dental benefit plans only cover orthodontic treatment that is provided, supervised and completed by a licensed dental professional.
Do you cover sedation services?
Sedation services D9222, D9223, D9239, D9243 and D9248 are covered, and subject to Professional Review.