|
|
|
|
FREQUENTLY ASKED QUESTIONS
|
Find answers to frequently asked
questions concerning benefits, claims, our Participating Provider
Organization (PPO) network, and electronic claims by clicking on the
questions below.
Who do I
contact for customer service?
Benefits:
Claims:
Participating Provider Organization
(PPO) network:
Electronic Claims:
Who do I
contact for customer service? (FAQ)
|
Ameritas prides itself
on the excellent service we provide to our partners and
customers. We know you will find our staff professional and
friendly with your questions and concerns. Please feel free
to contact us.
CUSTOMER RELATIONS is happy
to assist you with the following:
- Patient Eligibility
- Patient Benefits
- Claim Status and other
claims-related issues
CUSTOMER RELATIONS
Toll Free: 800-487-5553
E-mail: group@ameritas.com
Hours: Monday - Thursday 7
a.m. to 12:00 a.m./midnight CST
Friday 7:00 a.m. to 6:30 p.m. CST
PROVIDER RELATIONS is happy
to assist you with the following:
- How to become a participating
provider
- Network provider fee
questions
- Questions regarding your
provider contract
- Changing an address or tax identification number for
participating locations
- Obtaining a list of
participating providers other than by using the
Find a Provider search
PROVIDER RELATIONS
Toll Free: 800-755-8844
E-mail:
provider@ameritas.com
Hours: Monday - Thursday 7:00
a.m. to 6:00 p.m. CST
Friday 7:00 a.m. to 5:00 p.m. CST |
Benefits:
Can your insured members
receive services from any provider or must I be in the
Participating Provider Organization (PPO)? (FAQ)
|
Our insured members always
have a choice in selecting their own provider.
However, choosing a participating
provider in the Ameritas PPO 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
when treatment is performed by a participating provider.
Therefore, we recommend that you and your
patient contact us if you are unsure about how the choice of provider
may impact benefits. For a description of the member's
plan, you may view his or her
Benefit Information
on this web site.
If you have any additional questions
about our insured members'
choice of dentist and how it may impact
benefits, please contact Customer Relations
,
or e-mail questions to
group@ameritas.com. |
Will you send benefit payments
directly to the provider? (FAQ)
|
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.
If you have any additional questions
about benefit payments or claims-related issues, please contact
Customer Relations,
or e-mail questions to
group@ameritas.com. |
Am I a participating provider in
the PPO network? (FAQ)
|
The Find
a Provider search feature on this web site includes access to
the names and locations of participating providers in the Ameritas
PPO network.Please contact us if you
are unsure of your status as a participating or non-participating
provider in the Ameritas PPO network. Depending on the plan,
your status may impact your charges and/or your patients' benefits.
If you have additional questions
about membership status in the Ameritas PPO network, please
contact Provider Relations, or e-mail questions to
provider@ameritas.com.
|
My patient needs a referral to
another dentist/specialist. Any suggestions?
(FAQ)
|
Our insured members are
not required to receive an approval or obtain a referral from us to
see a provider. Members are welcome to seek treatment from any
dentist of their choice.
If possible, we suggest you refer the
member to a Ameritas participating dentist or participating
specialist to help the patient maximize his or her benefits.
Some plans offer higher benefit percentages, increased maximums and
reduced deductibles when treatment is performed by a participating
provider.
Use our
Find a Provider link on the
toolbar to access our online list of participating providers.
You may search for general dentists or for a specific type of
specialist.
If you or your patients have
questions concerning how the choice of a provider may impact
benefits please contact Customer Relations,
or e-mail questions to
group@ameritas.com.
If you need additional assistance
with finding a participating dentist in the Ameritas PPO Network,
please contact Provider Relations, or
e-mail questions to
provider@ameritas.com.
|
How do I obtain patient benefit information?
(FAQ)
|
- Use our
Member Information link on the toolbar to access a member's
dental benefit summary.
- Receive benefit summaries by fax:
|
Call 800-487-5553
Press 1 for dental
Press 2 for providers
Enter the plan member's
identification number
Select 6 and 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.
For more information on submitting a pretreatment
estimate visit our web page on
How to Submit a Claim or Pretreatment Estimate
.
- Ask the insured member to bring you his
or her certificate booklet, which outlines plan benefits and
limitations. For Scheduled Plans, the member's
certificate
booklet includes a list of the plan's
maximum allowances.
- If you have additional questions about
patient benefits, please contact Customer Relations,
or e-mail questions to
group@ameritas.com.
|
Do you require preauthorizations or
pretreatment estimates? (FAQ)
|
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.
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 on submitting a
pretreatment estimate visit our web page on
How to Submit a Claim or Pretreatment Estimate.
If you have additional questions
about pretreatment estimates, please contact Customer Relations, or e-mail questions to
group@ameritas.com. |
Claims:
How do I obtain claims
status information or a copy of an Explanation of Payment (EOP)?
(FAQ)
|
Please click the button labeled Member Information. This button is located at the top of the web page.
If you have additional questions
about claims status information or about obtaining a copy of an
Explanation of Payment (EOP), please contact Customer Relations, or e-mail questions to
group@ameritas.com. |
Do you accept electronic claims
submission and NEA attachments? (FAQ)
|
Yes, we accept
electronic claims submission.
Our Payor ID Number is 47009.
Yes, we accept NEA attachments & NIS/DENTRIX attachments.
|
What is your Payor ID number for
electronic claims submission? (FAQ)
What is your fax number for claims
submission? (FAQ)
|
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? (FAQ)
|
Group Claims
P.O. Box 82520
Lincoln, NE 68501-2520 |
Do you accept standard ADA
claim forms? (FAQ)
|
Yes, we accept claim forms that meet standard ADA guidelines. We do
not require our own original claim form. But, if you would like one, you
may
Download a Claim
Form here.
|
When should I submit x-ray films,
charting, and other supporting documentation?
(FAQ)
Who do I contact about a tax
statement, withholding or B-notice? (FAQ)
|
Contact Provider
Assistance by calling 800-366-5933 and selecting menu
option 2. |
Participating Provider Organization (PPO) network:
What type of provider
network is the Participating Provider Organization (PPO)?
(FAQ)
|
The Ameritas PPO
program
is a discounted fee benefit option made available to our client
groups for use by their employees. The PPO network is a
group of providers who agree to accept a discounted fee when
services are rendered for members with PPO access.
It is NOT a dental HMO or a capitation plan.
By being a provider in the Ameritas
PPO network, you have the opportunity to increase or maintain
your
patient base, expand referrals, and take advantage of benefits
that can help you with your office overhead costs.
Keep reading the FAQ and Join our Network pages for more information about the PPO program.
If you have additional questions, please contact
Provider Relations,
or e-mail questions to
provider@ameritas.com.
|
What benefits do you offer to a
provider in the PPO network? (FAQ)
|
The Ameritas PPO network
offers our participating providers many advantages that are
exclusive to the dental industry. By being a provider in the
network, you have the opportunity to increase or maintain your
patient base, expand referrals, and take advantage of benefits
that can help you with your office overhead costs such as:
- Electronic Claims Submission
Discounts
- EZ 2000 Dental Software Discounts
- Sterilizer Monitoring Program Discounts
- Malpractice Insurance Discounts
- Eye Protection in the Workplace Discounts
- OSHA Safety and Compliance Program Discounts
- Portable Oxygen Tank Discounts
Please view our online brochure describing the
Benefit Programs available
when joining the
Ameritas PPO network.
If you have additional questions, please contact
Provider Relations,
or e-mail questions to
provider@ameritas.com.
|
How will I get paid for my
services? (FAQ)
|
Depending on the
patient's
benefit plan type and the
service provided, reimbursement may be from Ameritas, from your
patient, or from a combination of both.
Based on contractual agreements, benefit payments are
automatically issued directly to providers who are in the Ameritas
PPO network.
General Dentists or Specialists in the PPO network agree to
accept the lesser of their usual and customary charge or their
Maximum Allowable Charge (MAC) from the fee schedule issued in
their contract.
Orthodontists in the PPO network agree to accept eighty percent
(80%) of their usual and customary charge for the service
performed.
For a copy of the MAC fee schedule for your area and specialty,
or if you have additional questions, please contact Provider Relations, or e-mail questions to
provider@ameritas.com.
Please indicate general dentist or specialist, and include your zip
code.
|
How do I obtain a current copy of
the PPO fees? (FAQ)
How will I know when my PPO
agreement becomes active? (FAQ)
|
Upon acceptance in the
Participating Provider
Organization (PPO), you will receive a copy of the executed
Ameritas PPO Dentist Participating Agreement containing your
signature along with a signature of a Ameritas officer, a
Participating Provider manual, and a letter welcoming you to the
program,
If you have additional questions, please contact Provider Relations, or e-mail questions to
provider@ameritas.com
. |
How will your insured members
know I participate in the PPO network? (FAQ)
|
Upon acceptance in
the Participating Provider
Organization (PPO), your name and location will be included on lists
provided to our members by mail or by phone and on our web site's
Find a
Provider search. Further, your name and location will also
appear on
the lists and web sites maintained by our partners who lease the
network.
Members who search
Find a Provider will see
your name, address,
phone number, and practice type (general or specialty), as well
as an option to access and print a map with directions to your
office.
If you have additional questions, please contact Customer Relations, or e-mail questions to
group@ameritas.com. |
What type of coverage is available to your insured members?
(FAQ)
|
We offer a variety of
plan designs tailored to meet
the needs of employers and employees, from routine preventive
coverage to comprehensive dental plans including orthodontia.
An overview of each member's
Benefit Information is included on
this web site. Also, we encourage obtaining pretreatment
estimates as the best way to determine a patient's
out-of-pocket
expense.
If you have additional questions concerning coverage, please
contact Customer Relations, or
e-mail questions to
group@ameritas.com. |
How will I know when a
patient has access to the PPO network? (FAQ)
|
The patient should
mention to you the name of his or
her coverage carrier and/or present you with an ID card.
Each insured member who has PPO network access is issued an ID
card that references the Ameritas PPO Dental Network.
Benefit Information is also available on this web site.
If you have additional questions, please contact Customer Relations, or e-mail questions to
group@ameritas.com.
|
Does Ameritas lease its PPO network?
(FAQ)
|
Yes. Ameritas has
special arrangements with
substantial companies who utilize our Participating Provider
Organization (PPO). They include:
- The Principal
- Reliance Standard Life, and in New York, First
Reliance Standard Life Insurance Company
- HealthPlan Services, Inc.
- Standard Insurance Company
If you have additional questions, please contact Provider Relations, or e-mail questions to
provider@ameritas.com.
|
Who do I contact to ask questions about the PPO network?
(FAQ)
Electronic Claims:
What are the advantages of
electronic claims submission? (FAQ)
|
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? (FAQ)
|
-
Your office will need to have a system that is linked to a clearinghouse with software or internet access.
- All electronic claims must be submitted through a
clearinghouse.
- Make 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.
- 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? (FAQ)
|
For information on
our contracted clearinghouses, please view this
eclaims brochure.
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.
|
|
|
|
