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Billing Guidelines & Resources

Here are some billing guidelines & resources. See our Claim Submission page when you’re ready to submit claims to us. 

 Registered Provider Central users can access additional resources on the site, such as fee schedules and payment policies.

Dental services

Use the following information to understand billing for dental services rendered by national dental network providers:

 Dental Blue Book (administrative policies)
 CDT Dental Procedure Guidelines and Submission Requirements
 Pediatric Essential Health Benefits Dental Procedure Guidelines & Submission Requirements

Other services

 Patient Protection and Affordable Care Act Preventive Care Services Billing Guideline
Use this billing guideline for information on certain preventive care services that are available without a cost to members. As always, please check member benefits and eligibility.

 Durable medical equipment

Refer to our General Coding and Billing payment policy () for information regarding:

  • Assistants
  • Locum tenens (when a physician works in place of another physician)
  • Assist at surgery
  • Payment for clinician services in a hospital teaching setting only
  • Modifiers 25, 59, XE, XS, XP, and XU