7 Claims and Payment - Premera Blue Cross

Premera Dental Reference Manual
Premera Blue Cross Blue Shield of Alaska
Section 5: Special Billing Situations
Anesthesia
Providers
When requesting reimbursement for general anesthesia under the medical benefit, follow
CPT guidelines and submit your charges on a medical claim form (the most common
code is 00170). Anesthesia for medical should be reported on one line item with total
minutes in the units field. If more than one anesthesia line is billed for the same date of
service, only the first anesthesia services is allowed and all others will be denied.
When requesting reimbursement for anesthesia under the dental benefits plan submit
your charges following the CDT guidelines (see instructions under Billing Instructions).
Treating/Self
and Family
Members
Premera follows many Medicare guidelines. Similar to Medicare, we do not reimburse
for professional services or supplies that are usually provided free because of the
relationship to the patient.
As a reminder, physicians, providers or suppliers who are Premera members, are not
reimbursed by us for professional services for any of the following when services are:
Performed on themselves, or
Rendered to family members residing in the home, or
Provided to individuals related to them by blood, marriage, or adoption.
Locum
Tenens
A locum tenens dentist does not need to be credentialed because he/she is considered a
temporary provider. A locum tenens physician bills under the name of the absent,
contracted dentist.
Exception: if a locum tenens dentist provides services for more than 90 days, he/she
must be credentialed.
Claims and Payment Chapter 7 Page 8