Are you changing Tax IDs, moving, making a change to the rendering dentist, or just submitting an Orthodontia claim?
Here’s some information on what you need to do to get paid correctly.
To help ensure that you’re properly compensated for orthodontia claims, we have compiled the following recommendations for claim submission.
The following information must be included with your orthodontia claims:
- Complete description of treatment, including appropriate CDT codes
- The same itemized maximum allowable fees listed above also apply to cosmetic or Invisalign®(aligner) services
- Total standard office treatment fee including, if applicable, records and retention. Maximum allowable fees should be itemized, including:
- Total case
- Initial banding date
- Months of active treatment
- Date(s) of service, including fee for diagnostic records
- Fee for retainers
What happens next?
Once you have submitted the required information for orthodontia claims, submitting claims for monthly adjustments is unnecessary. Cigna Dental makes automatic quarterly payments. This process alleviates the need to submit unnecessary paperwork.
For your reference, review the sample of a completed orthodontia claim.* It is important to include the date services are rendered, as shown in the claim sample, for Invisalign and Records.
We realize you intend to collect your DPPO contracted fee from Cigna customers. To receive proper compensation, orthodontia claims should be filed according to your regular orthodontia fees. The initial work-up, banding, or activation is compensated at 25% of the total months of treatment based on your fee, with payments not to exceed your contracted fee. The 75% balance is paid quarterly over the remaining months of treatment. Therefore, submitting your regular fee to reflect the true cost of orthodontic treatment is important.
Cigna will pay up to their liability of the treatment plan or the lifetime maximum, whichever comes first.
If you’ve changed any of your information or are changing the rendering Dentist on an Orthodontia case, please contact your Provider Relations Manager to ensure that active orthodontia treatments are handled correctly.
*This example is used for illustrative purposes only. Actual procedure codes and amounts may vary. If you have questions, contact Provider Services.