submit a claim or pre-treatment estimate
We understand that flexibility is essential for quality service. That’s why we accept claims electronically, by fax 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.*
We accept dental claims from a number of clearinghouses that offer a variety of electronic claims tools and solutions, including DentalXChange, Change Healthcare, and Tesia.
our payer ID: 47009
our payer ID: (NY) 72630
We also have services for electronic attachments such as x-rays and radiographs. We use NEA and Tesia clearinghouses for these types of attachments.
Download a claim form.
Send claims to:
Group Claim Office
PO Box 82520
Lincoln, NE 68501
Please use the Claim Submission Checklist below so we can quickly process your claims.
- X-ray films, radiographs and/or charting should accompany claims or pretreatment estimates with surgical, major restorative and/or periodontal procedures. Read the Claims Filing Reference Guide for more information about when to send attachments.
- 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.