FAQs

How do I verify which plan my patient has?

Each member is issued a member identification card. Some may have a dental plan ID card that has the plan name on the front of the card and the dental claim mailing address and customer service number on the back. Other members may present a Florida Blue health plan ID card that may or may not specify dental benefits. We recommend that you review the information on the patient’s ID card and submit all claims to the address indicated to ensure timely claims processing.

We also recommend verifying your patients’ benefits at the MyDentalCoverage website or calling customer service at 866-445-5148. You can verify the benefits of patients who have FEP Dental, FEP, Grid, and Grid Plus plans at other plan-specific websites that require registration. You can find the contact numbers for all our plans on the Contact us page.

How can I verify my patients’ benefits and eligibility?

You can access benefit information for our members and process claims reimbursement quickly and easily through the MyDentalCoverage website. FEP Dental, FEP, Grid, and Grid Plus members have separate websites that require registration.

How do I submit claims?

Claims can be mailed or submitted electronically. When you submit a claim, be sure to include the appropriate CDT procedure code, including the total treatment fee and the placement date of an appliance (if applicable).

Claims can be submitted electronically through the MyDentalCoverage website. Florida Combined Life’s payor ID is 76031. You can also use the Speed eClaim® service, which submits the claim directly us instead of through a clearinghouse.

Please make sure that your claims submission information, including the NPI for the rendering provider and the billing practice, rendering address, and billing address, are accurate in your electronic health record systems and with your clearinghouse. For other contact information and mailing addresses, please Contact us.

You can also mail all claims for all plans (except FEP, GRID, and prepaid plans) to:

FCL Dental
P.O. Box 69436
Harrisburg, PA 17106‐9436

How do I enroll in Electronic Funds Transfer (EFT)?

You will need to register on MyDentalCoverage to receive EFT payments. Once registered, you can manage or review your payments by clicking the “Electronic Funds Transfer” link on My Dental Coverage’s homepage.

How am I reimbursed for treating FEP Dental and Grid plan members?

The claims and customer service functions for Federal Employee Dental Program (FEP) plans are administered through the Blue Cross and Blue Shield Association. The FEP membership card is identified by coverage enrollment codes 104, 105, and 106 for the Standard Option and 111, 112, and 113 for the Basic Option.

You can verify member eligibility by calling the FEP Customer Service Center at 800-333-2227.

If you are a participating FEP provider, you are also a participating provider in the GRID network. These members carry ID cards with either GRID or GRID+ on the back of the card.

When applicable, the covered dental services you provide to these members will be based upon the current area’s BlueDental Choice PPO fee schedule.

You can find more information about FEP, FEP Dental, and Grid plans, including samples of member ID cards and how to file a claim or obtain reimbursement, in our Dental Manual and Guidelines.

Where can I find fee schedules?

You can access all current fee schedules at MyDentalCoverage.

Your Type 1 NPI (individual and unique to provider) is required for access. You can verify your NPI information at the NPPES NPRI Registry website.

Which services are available through the MyDentalCoverage website?

MyDentalCoverage is your primary resource for obtaining member benefits, claims, and eligibility information. You can register for electronic funds transfer (EFT), view remits directly, submit pre-treatment estimates, add attachments to a claim, and chat online with a dental customer service representative. It also includes the Speed eClaim service, which streamlines claims submission.

By clicking on the My Patients’ Benefits link on the homepage, you can securely access patient information, including eligibility, benefits, enrollment, claim status, allowance information, maximums, deductibles, and procedure history.

How do I create an account on MyDentalCoverage to verify my patients’ eligibility and benefits?

To set up your account:

1. Visit MyDentalCoverage and select My Patients’ Benefits.

2. On the “Account Access” page, click Create an Account.

3. Follow the prompts and enter the details requested on each page until completion.

You’ll need to have the following information on hand when creating an account:

• Provider ID or National Provider Identifier (NPI) number

• Provider Tax ID (EIN) or Social Security Number

Once your account is set up, you can check eligibility and benefits, patient history, and claims reimbursement. You can also easily handle preauthorization, electronic funds transfer (EFT), and electronic claim filing.

How do I report changes to my practice?

If there have been any changes to your practice’s address, phone number, tax ID numbers (TINs), and practice affiliations, we ask that you complete and submit the appropriate status update form on the Update your status page as soon as possible. The forms are available electronically through DocuSign.

Reminder: Anytime you make a change to your TIN, you will need to sign a new dental agreement. If you are changing your practice location, employer identification number (EIN), or TIN, please attach a copy of your IRS Form 147c or CP575 by clicking the paperclip icon in DocuSign.

When updating your practice’s information, be sure to select and specify a location drop-down option. This makes it easier for members to find your practice.

Am I an in-network provider for Florida Blue Medicare Advantage?

If you participate in our Medicare Advantage (MA) network, you are considered in-network for Florida Blue’s MA members. These members have a Medicare Advantage HMO or PPO medical plan with embedded dental PPO benefits.

You can verify your participation in the MA network through the MyDentalCoverage website or by calling 866-445-5148. If you’d like to join our Medicare Advantage network, please contact your provider network manager or visit the Update your status page on our website; there, you’ll find the forms you need to complete in order to be added to the network.

How do I know if a patient’s Florida Blue Medicare Advantage plan includes dental benefits?

While not all Florida Blue MA plans offer dental benefits, those that do ALL have embedded PPO dental benefits, whether a member has an HMO or PPO MA health plan (see the chart below). The health plan ID card issued to Florida Blue MA members also serves as their dental ID card. You may find that the medical plan type is not necessarily the same as the dental type.

How am I reimbursed for Medicare Advantage plans?

Reimbursement is paid according to the Medicare Advantage schedule of allowances, which you can find in Fee schedules.

What’s the difference between Medicare Advantage and Original Medicare?

The Centers for Medicare and Medicaid Services (CMS) offer original Medicare plans, and private insurers offer MA plans. MA plans have benefits not typically included in Original Medicare. These benefits include oral evaluations, diagnostic imaging, cleanings, preventive, restorative, endodontics, oral surgery, periodontics, and prosthodontics.

Does CMS have any requirements for providers of Medicare Advantage program benefits?

Yes. CMS requires all persons involved in the administration or delivery of MA Program benefits to complete the following general and specialized Medicare compliance training annually:

Combating Medicare Parts C and D Fraud, Waste and Abuse

Part C Organization Determinations, Appeals, and Grievances

Part D Coverage Determinations, Appeals, and Grievances

Providers are required to email the Certificates of Completion to dentalproviderrelations@fclife.com.

Where can I find detailed information about Medicare Advantage network participation?

You can find details about the network, including member ID card examples, in our Medicare Advantage Dental Manual.

Do Medicare Advantage plans include Oral Health for Overall Health?

Yes. All Florida Blue Medicare Advantage plans that include dental coverage, except for Florida Health Care Plans (FHCPs), include the program.

What is the Oral Health for Overall Health program?

Members with Florida Blue health and dental plans and eligible medical conditions affected by oral health are automatically enrolled in our Oral Health for Overall Health^SMprogram (members with only a BlueDental plan can self-enroll). They receive additional dental benefits that have been shown to improve overall health and lower medical and dental care costs.

We recommend you thoroughly review a patient’s medical history before starting treatment. After confirming the condition(s) that enabled their enrollment, please call us at 866-445-5148 or review the information on the MyDentalCoverage website. After clicking on the My Patients’ Benefits link, select the Wellness Benefits tab. Their conditions and enrollment date will be displayed. The Limitations column includes specific details about which procedures are covered for each qualifying condition.

To ensure your enrolled patients take advantage of these valuable benefits, we recommend that you schedule all four preventive visits during their first visit to your office.

Which medical conditions are eligible for the program?

Your patient is eligible for Oral Health for Overall Health benefits if they are enrolled in the program, have a dental plan that permits enrollment, and have been diagnosed with one or more of the following medical conditions: chronic obstructive pulmonary disease (COPD), coronary artery disease, stroke, diabetes, end-stage renal disease (ESRD), metabolic syndrome (MetS), pregnancy, Sjögren’s syndrome, and oral, head and neck cancers.

Patients with eligible medical conditions with Florida Blue health and dental plans are automatically enrolled in the program. If they have only a BlueDental plan, they can easily self-enroll.

Which services are included in the Oral Health for Overall Health program?

Program benefits available through the Oral Health for Overall Health program are valued at more than $1,000—which is also additional revenue for your practice. The program includes education and ties dental into Florida Blue care coordination programs.

• Services are covered 100% and don’t count toward members’ annual maximum—eliminating out-of-pocket costs increases the likelihood of eligible patients taking advantage of the program’s benefits.

• The benefits don’t count toward the calendar year maximum, and there are no waiting periods.