Dental Providers: Submit a Claim or Pretreatment Estimate
We understand that flexibility is essential for quality service. That’s why we accept claims electronically or through the mail. Whatever your preference, we’ll work with you.
To submit claims electronically, it’s important to have the appropriate software or internet access – we recommend EZ 2000 software. Once your information is entered, it will be sent to a claim clearinghouse partner. There is a per claim fee for this service, and our network providers are reimbursed up to 30 cents for eClaims.*
Dental claims are accepted from a number of clearinghouses that offer a variety of electronic claims tools and solutions, including DentalXChange, Change Healthcare, Vyne, and Zelis Payments.
Ameritas payer ID: 47009
Ameritas of New York payer ID: 72630
Mail claims to:
Group Claim Office
PO Box 82520
Lincoln, NE 68501
Use the checklist below to reduce claims processing time.
- Read the Claims Filing Guide for general review guidelines and details on when X-ray films, radiographs and/or charting should accompany claims or pretreatment estimates.
- Include prior placement dates for any replacement crowns, onlays, bridges, dentures and partial dentures.
- Include narratives or surgical notes if they might add to our consultants’ understanding of the diagnosis (X-rays alone may not be instructive).
- Provide tooth numbers, quadrants and arch locations if needed.
- Use current CDT codes for each procedure.
- Include your Tax ID Number or Social Security Number.
- Include the name of the treating dentist and the location where services were rendered.
- Remember to sign the claim form.
*Please note: reimbursement of electronic claim applies to Ameritas network providers. Quarterly checks will be issued (February, May, August, November) for amounts of $25 or greater. Reimbursement will be on a cumulative basis.
Utilization review and appeals
A covered person, their representative or their dental provider have the right to file an appeal or submit a written request for a review of a benefit determination within 180 days, in most states, of receiving notice of the determination. For more information on appeals rights in your state, visit the forms page. Appeals may be submitted to the Ameritas quality control department. Quality Control PO Box 82657 Lincoln, NE 68501-2657 Fax 402-309-2579 The written request must include:- Member name and member ID
- Claim number
- Reason for appeal
- Additional information not already submitted to explain why the benefit should be allowed. This may include treatment notes, X-rays, or intra-oral photos.
- Copies of any non-privileged information related to the appeal.
- Names of expert consultants who provided advice about the claim.
- Clinical rationale and/or specific guidelines used in the benefit determination.
Notice: Dentist shall cooperate with covered persons and Ameritas in resolving any covered persons’ grievances to resolve disputed incorrect or incomplete records or information. Dentist shall provide Ameritas, if requested, access to covered persons’ patient records for the purpose of quality oversight and grievance resolution.
This information is subject to state regulations and may change or be updated for new state requirements, updates to ADA codes, or specific policy requirements.