Dental Policy disclaimer

The Dental Policy Manual is intended only for dental providers and other health care professionals, except where otherwise indicated.

By clicking "I Accept" below, you acknowledge your understanding and agreement with the following:

Description

This Dental Reimbursement Policy Manual documents payment methodology for some dental services and supplies.

THIS DENTAL REIMBURSEMENT POLICY MANUAL DOES NOT APPLY TO ANY OTHER COMPANY.

Use

Dental Reimbursement Policy is used by the Company to provide consistent and predictable claims payment.

Conflict with Other Documents

Dental Reimbursement Policy facilitates the systematic application of our member contracts, provider contracts, and dental policies. In the event of a conflict between a Dental Policy and any Plan document under which a member is entitled to Covered Services, the Plan document will govern. Plan documents include, but are not limited to, Subscriber Contracts, Summary Plan Documents, and other coverage documents prepared by a Plan.

Restrictions and Limitations

  • Dental Reimbursement Policies do not determine the schedule of benefits. Rather, Dental Reimbursement Policies support the schedule of benefits by establishing payment rules, coding hierarchy, and related processing systems’ edits.
  • While Regence seeks input and feedback from members and providers, Dental Reimbursement Polices shall be interpreted and modified in the sole discretion of the company.
  • Dental Reimbursement Policy application is subject to state and federal laws and specific instructions from Plan Sponsors of self-insured groups.
  • Dentists and other oral healthcare providers are expected to exercise their dental judgment in providing the most appropriate care. Dental Reimbursement Policies are not intended to dictate dental practice and do not constitute dental advice.
  • Dental Reimbursement Policies are the property of the Company and are prohibited for commercial use. Commercial use does not include use of the Dental Reimbursement Policies related to benefit payment for oral health care services received by one of our members.
  • Dental Terminology (CDT®) codes and descriptions are the property of the American Dental Association (ADA) with all rights reserved. Any unauthorized use of CDT® codes is prohibited.
  • The coding software guidelines are incorporated into the Dental Reimbursement Policy by reference. Thus, to the extent there are situations not documented in the Dental Reimbursement Policy, coding software guidelines control.
  • Dental Reimbursement Policies may be revised from time to time. The Company will provide ninety (90) days written notice when appropriate of Dental Reimbursement Policies or Coding Toolkit updates where we develop the editing criteria that result in a reduction to compensation.
  • There is no obligation to update this site and the Dental Policies displayed may be out of date.

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