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Submit rendering provider site address in box 56
March 13, 2023

This article is for dentists caring for our members

For practices that have more than one location, please be sure to submit the rendering/treating provider’s address.  This will help your claim process more accurately. Here’s how:

For this type of claim Please
Electronic Complete the following fields:
  • Rendering provider name
  • Service facility location name
  • Service facility location address
Paper Complete box 56 along with the other fields listed within the “Treating Dentist and Treatment Location Information” section as shown below.

Populate box 49 with the group NPI and billing address.

MPC_010323-1P-7