We do not require attachments to be included as part of an initial dental claim unless indicated on our clinical edits by code lists. Sending unsolicited attachments can delay the processing of your claim.
If additional information is required to process your claim, we will send you a request.
Attachments that we may request may include:
- Chart notes
- Accident reports
- Operative reports
- Laboratory reports
- Dental or medical records
Certificates of medical necessity
Please submit coordination of benefit (COB) information as part of your standard American National Standards Institute (ANSI) 837 health care claim transaction. Do not submit COB as an attachment.
Use the Supporting documentation coversheet (PDF) to submit documentation. This standard cover sheet ensures your documentation is associated with the right claim(s) and expedites processing. Please complete all fields on the form and:
- Include the claim number
- Include the office contact information
- Complete all subscriber and patient information
- Do not use for corrected billings or billing disputes
- Indicate if claim was submitted electronically if applicable
- In the comment section indicate what type of documentation is attached