Sometimes submitting a claim can be confusing. So, here are some tips on how to make sure everything is submitted correctly.
Remember you must include the following information when submitting a claim:
- Member’s name
- Member ID number
- treating dentist name
- tax ID number
- Social Security Number
- address where services were rendered
- date of service
- procedure codes
- procedure descriptions
- your Usual and Customary Fee
- the amount charged
- tooth number
- surfaces/quadrants
- location/arch
All charges should be submitted to the Dental Plan using one of the following methods:
- Electronically, through a clearinghouse that provides an electronic interface with third-party Payers
- Via standard ADA Dental Claims Forms
- Via a Dental Plan Claim Form
- Forms that any state regulations may require
Paper claims should be submitted to the following addresses:
DPPO/Indemnity Claims
Cigna
PO Box 188037
Chattanooga, TN 37422-8037
DHMO General Dentists
Cigna
PO Box 188046
Chattanooga, TN 37422-8046
DHMO Specialist
Cigna
PO Box 188045
Chattanooga, TN 37422-8056
Electronic claims submission
Submitting dental claims electronically can help you save time, money, and improve claim processing accuracy. Using one of Cigna’s EDI options allows you to send, view, and track claims – no faxing, printing, or mailing required. Everything is right on your desktop.
Benefits of submitting claims to Cigna electronically
- Quicker claims submission, including DHMO encounters
- Receive payments faster
- Improve claims accuracy – reduces errors and missing data
- Track claims received electronically, which are automatically archived before processing
- Save time on resubmissions – incomplete or invalid claims can be reviewed and corrected online
- View, track, and monitor claim status reports
- Send primary and secondary coordination of benefits (COB) claims quickly, reduce paperwork, and eliminate printing and mailing expenses
How to submit claims electronically
EDI vendors– To connect electronically with an EDI vendor, you only need a computer and a printer. Costs vary by practice management system vendor or clearinghouse. Some practice management software companies may offer free claim submissions for the first three to six months. Cigna is directly connected to three vendors who provide web claim data entry for dental offices that have internet access but no office management system. Visit Cigna.com/EDIvendors to learn more.
Using Payer ID 62308, you can electronically submit all claims and encounters at the same time – indemnity, DPPO, and DHMO. This includes general dentistry and specialty encounters. Both primary and secondary COB claims should be submitted to Cigna electronically.
Submit X-rays electronically
You can submit X-rays and other attachments electronically through any of the following options.
- Standard EDI 275 attachment transactions through your clearinghouse
- DentalXChange Attachment Serviceavailable free of charge for DentalXChange Claim Connect™ subscribers
- NEA FastAttach®– Secure information exchange that is cost-effective and reliable. To learn more, visit National Electronic Attachment (NEA) FastAttach at nea-fast.com or call 800.782.5150. Discounts are available for Cigna Dental network dentists through the Cigna Network Rewards Program®.
Electronic submission eliminates the need for duplicate X-rays or self-addressed, stamped envelopes.
- Visit CignaforHCP.com > Resources > Payment Guidelines > Electronic Claim Submission to learn more.
- For Information on Cigna Network Rewards, visit CignaforHCP.com > Resources > Dental Resources > Cigna Network Rewards Program.
Save time – submit your claims electronically
To learn more about electronic claims submission with Cigna, log in to the Cigna for Health Care Professionals website at CignaforHCP.com > Resources > eCourses, or call 800.Cigna24 (800.244.6224).
- Not registered to use the website? Go to CignaforHCP.com and click “Register Now.”
Note: For claims with no service dates, the 276/277 transaction will default to the process date.
For questions about claims submitted through your clearinghouse, contact the clearinghouse directly. For questions about Cigna claim processing, call Customer Service at 800.Cigna24 (800.244.6224).
Claim inquiry and follow-up
You can inquire about the status of your claims through several methods: EDI transaction 276/277, the Cigna for Health Care Professionals website at CignaforHCP.com, our interactive voice response system, or by speaking with a customer service representative at 800.Cigna24 (800.244.6224).
Provider appeals and complaints
Cigna strives to resolve issues raised by health care providers on initial contact whenever possible.
An appeal is defined as a request to change a previous adverse decision made by Cigna when Cigna has determined that the original decision was correctly adjudicated.
A complaint is considered an initial expression of dissatisfaction from a provider or their representative regarding any issue about coverage, service, contractual disputes, etc.
Cigna offers an appeals process for dentist terminations, contractual disputes regarding post-service payment denials and payment disputes, denial of dentist network participation, or when state law requires appeals for other reasons.
Before beginning an appeals process, please call Cigna Customer Service at 800.Cigna24 (800.244.6224) or the number on the member’s ID card to try to solve the issue. Many issues, including denials related to timely filing, incomplete claim submissions, and disputes over contracts and fee schedules, can be quickly resolved through a real-time adjustment by providing the requested or additional information. If our Customer Service team cannot resolve the issue during the call, our appeal process can be initiated through a written request.
If a Network Dentist wishes to appeal any decisions, they must submit the appeal in writing to Cigna within 180 calendar days of the initial denial, EOB, or letter. Based on the product, the request should be submitted to the respective address:
DPPO
Cigna
PO Box 188044
Chattanooga, TN 37422-8044
DHMO
Cigna
PO Box 188047
Chattanooga, TN 37422-8047
If you have any questions about submitting a claim, please contact the Cigna Dental Provider Services Unit at 800.88Cigna (800.882.4462), Monday through Friday, between 9:00 a.m. and 7:00 p.m. ET. Through the voice prompts, enter your tax identification number, request “provider,” and identify yourself as a “dental” caller.
We will be happy to help you through the process.