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Provider FAQ

Ameritas Dental Network

Does Ameritas lease its dental network?

Yes.  Ameritas has special arrangements with companies who utilize our network.  To view, log-in to our Secure Provider Portal and go to the Resource Center.

Last updated 02/28/2020

This enables Ameritas to advertise your practice to a wider range of groups, giving you exposure to more patients.  Insured members will have an ID card that includes the Ameritas logo.

Is this a capitation/dental DHMO program?

No. You will be reimbursed according to the contract fees in your area and for your specialty type. There are no monthly eligibility rosters or a referral process. This is a program that you will be able to integrate into your practice with ease.

How can I find benefit information for a patient and/or if the patient has the Ameritas PPO benefit?

Eligibility and benefit information is right at your fingertips. By completing the requested insured member information, you will be able to access their benefits.

How will I get paid for my services?

You will be paid in accordance with the contract fees and the patient’s benefit plan. Depending on the patient’s benefits and the services provided, your reimbursement may be from Ameritas, the patient or a combination of both.

Am I expected to accept assignment of benefits?

Yes, the terms of the Ameritas Dental Agreement require payment be made to the dental provider.

How will insured members know I participate on the Ameritas network?

They can visit our website at where we will advertise your office facility information via our online provider directory.

How often is the directory updated?

Our online directory is updated on a daily basis, which allows members to have access to current network information.

Can your insured members receive benefits from any provider or must they see a network provider?

A member always has a choice in selecting their own dental provider. However, by choosing a network provider, they can help curb rising benefit costs while saving out-of-pocket expenses. Many insured members choose a network provider for these reasons.

What should be done if an insured member needs a specialist?

We suggest you refer the member to an Ameritas network specialist, if possible, to help the patient maximize their benefits. You do not need to receive approval from Ameritas to refer a patient to a specialist. To obtain a list of network specialists in your area, visit our online provider directory.

Who do I contact about becoming a member of the Ameritas dental network?

You may request an application packet by contacting our Provider Relations Department at 800-755-8844, ext. 88327 or by sending an e-mail to providerrelations@ameritas.com.

Am I automatically accepted onto the network after completing the appropriate paperwork?

No. Ameritas’ in-house Provider Relations Department is responsible for credentialing each application received. A provider will be added to the dental network once all credentialing and quality assurance requirements are successfully completed.

How will I know if I am a Network Provider?

Upon acceptance in the Ameritas Dental Network, you will receive a welcome letter along with a copy of your executed Ameritas Dental Agreement.

How do I obtain a current list of contract fees?

If you are considering participation on the Ameritas network, you may contact the Provider Relations Department at 800-755-8844, ext. 88327.  Once you are an active network provider, current fee schedules are available online.

How often are contracted fees reviewed?

Ameritas contract fees are reviewed on an annual basis.

What types of benefit programs do you offer network providers?

Ameritas offers several discounts on items that may be beneficial to your dental practice. Our reward programs provide savings on spore testing, dental software, eye protection and much more. View the Reward Programs available when you join the Ameritas network.

Who can I contact with questions about the network program?

Please feel free to contact our Provider Relations Department at 800-755-8844, ext. 88327.

Monday – Thursday: 6:30 a.m. – 5:30 p.m. CST
Friday: 6:30 a.m. – 4:30 p.m. CST

What are my obligations to arrange for emergency coverage and routine appointments?

Dentist shall remain solely responsible for the quality of dental services provided and appropriate care to the Covered Person. Dentist understands and agrees that no financial incentive program exists that compensates Dentist for ordering or providing less than medically necessary and appropriate care to his/her patients. Dentist shall also provide or arrange call coverage or other back-up for twenty-four (24) hours per day, seven days per week during vacations and/or other periods his/her office might normally be closed, or make other arrangements for such coverages at Dentist’s expense. Dentist shall offer appointments to all Covered Persons upon request within a reasonable time. For non-emergency appointments other than exam, cleaning, and/or x-ray(s), a reasonable amount of time shall not be more than thirty (30) days, unless state laws and regulations require that routine appointments for non-emergency care shall be available within a different specified time frame.

Benefits

Can your insured members receive services from any provider or must I be in the Ameritas dental network?

Our insured members always have a choice in selecting their own network provider.

However, choosing a network provider in the Ameritas dental network where available may result in the member receiving reduced out-of-pocket costs. Some plans offer higher benefit percentages, increased maximums, and reduced deductibles or copayments when treatment is performed by a network provider.

Therefore, we recommend that you and your patient contact us if you are unsure about how the choice of a network provider may impact benefits. For a description of the member’s plan, verify his or her benefit information:
Verify Patient Benefits
Verify Patient Benefits (NY)

Will you send benefit payments directly to the provider?

Yes, for services performed in the United States.

To receive benefit payments directly, non-participating providers must submit a properly executed “Assignment of Benefits” with each claim. We also accept “Signature on File.”

Based on contractual agreements, benefit payments are automatically issued directly to providers who are in the Ameritas PPO network.

Am I a participating provider in the PPO network?

The online provider directory on this website includes access to the names and locations of participating providers in the Ameritas PPO network. Depending on the plan, your status may impact your charges and/or your patients’ benefits.

My patient needs a referral to another dental provider. Any suggestions?

Our insured members are not required to receive approval or obtain a referral from us to see a provider. Members are welcome to seek treatment from any provider of their choice.

If possible, we suggest you refer the member to an Ameritas participating provider to help the patient maximize his or her benefits. Some plans offer higher benefit percentages, increased maximums and reduced deductibles or copayments when treatment is performed by a participating provider.

Use our online provider directory to access our online list of participating providers. You may search for general dentists or for a specific type of specialist.

How do I obtain patient benefit information?
  • Sign into your secure provider account and select the Member Information tab.
  • Receive benefit summaries by fax:

    Call 800-487-5553
    Pressfor dental
    Pressfor providers
    Enter the plan member’s identification number
    Selectand enter your fax number

  • Submit a pretreatment estimate. We recommend that a pretreatment estimate be submitted for all anticipated work that is considered to be expensive by our insured members. For more information, visit How to Submit a Claim or Pretreatment Estimate.
  • Ask the insured member to bring you his or her certificate, which outlines plan benefits and limitations. For Scheduled Plans, the member’s certificate includes a list of the plan’s maximum allowances.
Do you require preauthorizations or pretreatment estimates?

Pretreatment estimates are the best way to determine a member’s out-of-pocket expense. We recommend submitting pretreatment estimates for all anticipated work that is considered to be expensive by our insured members.

A pretreatment estimate is not a preauthorization or guarantee of payment or eligibility; rather it is an indication of the estimated benefits available if the described procedures are performed.

For more information, visit How to Submit a Claim or Pretreatment Estimate.

Claims

How do I obtain claims status information or a copy of an Explanation of Payment (EOP)?

Sign into your secure provider account and select the Member Information tab.

Do you accept electronic claims submission and electronic attachments?

Yes, we accept electronic claims submission. Our Payor ID Number is 47009 and 72630 (NY).

Yes, we accept NEA attachments, Tesia eAttachments and DentalXChange attachments.

What is your Payor ID number for electronic claims submission?

47009
72630 (NY)

What is your fax number for claims submission?

Claims not requiring x-ray films may be faxed to 402-467-7336.

Please see our Claims Filing Reference Guide for details on when to submit x-rays and/or other supporting documentation.

What is your mailing address for claims submission?

Group Claims
PO Box 82520
Lincoln, NE 68501-2520

Do you accept standard ADA claim forms?

Yes, we accept claim forms that meet standard ADA guidelines. We do not require our own original claim form. If you would like to use our claim form, download a copy here

When should I submit x-ray films, charting and other supporting documentation?

Please review our Supporting Documentation Flyer. Feel free to print a copy for your office’s use.

Additional information about claim requirements is available on our How to Submit a Claim or Pretreatment Estimate page.

Who do I contact about a tax statement, withholding or B-notice?

Contact Provider Assistance by calling 800-366-5933 and selecting menu option 2.

What is our Utilization Review Program?

Utilization review involves a set of guidelines designed to determine benefits by incorporating the dental policy limitations and coding as defined in the Current Dental Terminology© American Dental Association. We have established a utilization review program to ensure that any guidelines are used consistently, are clearly documented and include procedures for applying such criteria based on the documentation submitted. This criteria was developed with involvement of dental consultants who are licensed dentists. The program is reviewed on an annual basis to ensure that the guidelines are current with dental technology, evidence-based research and any dental trends.

During the review of submitted procedures, there may be a determination by a qualified and appropriately licensed dentist that the procedure(s) do not meet the contractual limitations as outlined in the specific dental policy and/or coding as defined in the Current Dental Terminology© American Dental Association. When a claim has been denied or partially denied based on the contractual limitations of the dental policy and/or coding as defined in the Current Dental Terminology© American Dental Association or an alternate benefit was recommended, this is considered an adverse determination.

Electronic Claims

What are the advantages of electronic claims submission?

Electronic claims submission is a way for you to reduce some of the expenses associated with running your practice and a way for us to expedite claim processing.

  • We process claims submitted electronically the day they are received.
  • Electronic claims submission eliminates postage and envelope expenses.
  • Electronic claims submission tracking eliminates lost claims and allows for immediate follow-up regarding transmission status.
  • Many practice management systems allow entry of information once for both accounting and claims submission.
  • Reduced transaction fees are available for participating providers of our PPO network.
What do I need to submit electronic claims?
  1. Your office will need to have a system that is linked to a clearinghouse with software or internet access.

  2. All electronic claims must be submitted through a clearinghouse.

  3. Be sure to submit electronic claims under the same tax identification number that you would use on a paper claim. If you change this number with the IRS, please be sure to notify Ameritas of these changes.

  4. To ensure that your electronic claim is processed properly, please be sure to include the following information:

    • Name of the “treating” dentist

    • Tax Identification Number (or the dentist’s identification Number)

    • Office address where services were performed

It is imperative that you include the above information even if you submit under a “corporate business name.

“Submit ALL claims electronically even if you think a claim needs an attachment. Ameritas will let you know if additional information is needed. Many claims can be processed utilizing the narrative or claim remark field to provide replacement dates or pocket depths. Ameritas will accept up to 250 characters in this field.

Ameritas’ Payor ID Number is 47009.

Who do I contact with questions about electronic claims submission?

View our eClaims brochure for information on our contracted clearinghouses.

If you are having problems setting up your electronic claims capabilities or sending electronic claims, please contact your clearinghouse, vendor or billing service first. They can review your daily reports to identify any transmission errors and let you know if further research is needed.

You may also contact us at 800-659-2223, ext. 2217.