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.
Use the following information to understand billing for dental services rendered by national dental network providers:
Under the Patient Protection and Affordable Care Act (ACA), certain plans must cover “essential health benefits” (EHBs). Each state selects an existing health plan as a benchmark of what benefits must be included. Because Massachusetts selected the Child Health Insurance Plan (CHIP) as the benchmark plan, the pediatric dental benefits in that plan are considered Essential Health Benefits (EHB) in Massachusetts.
The No Surprises Act, enacted as part of the Consolidated Appropriations Act (“CAA”) in late 2020, provides new federal consumer protections against balance billing for certain medical bills under certain circumstances. Claims subject to balance billing protections may occur:
We want to let you know how we’re educating our members about their rights and protections under the law. We post disclosures explaining the rights and protections our members have under the law to our public website: bluecrossma.org/disclaimer/member-rights. Our Explanation of Benefits (EOB) when we pay bills covered by the law will direct members to the following explanation of the law:
Under the No Surprises Act, non-participating providers are prohibited from balance billing under the circumstances described above.
The statute requires providers, including hospitals, to make notice about balance billing requirements and prohibitions publicly available and provide them to consumers. The regulations supporting the No Surprises Act detail information that must be included in such notice.
The federal law also includes provisions allowing providers to request negotiation of the payor’s payment for bills subject to the No Surprises Act, and if negotiation fails, to enter into the Independent Dispute Resolution (IDR) process, also known as arbitration, to determine the allowed payment amount.
|Mail:||Blue Cross Blue Shield of MA
PO Box 986065
Boston, MA 02298
Please include "Surprise Bill Negotiation Request" in the header of your letter.
|Phone:|| 1-800-882-2060 (physicians)
1-800-451-8124 (ancillary providers)
Please include "Surprise Bill Negotiation Request" in the subject of your email.
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.
Refer to our General Coding and Billing payment policy () for information regarding: