BlueCard and Dental Claims

Dental Claims for BlueCard® (Out-of-State) Members

  • Dental providers and oral surgeons must verify benefits of BlueCard® Program members prior to performing services by calling the number on the back of the member's ID card.

Using ADA Claim Form

  • Dental services claims on an ADA form must be submitted and processed through the Blue Plan named on the member's ID card; do NOT file with Blue Cross and Blue Shield of Louisiana (BCBSLA).
  • Call the number provided on the member's ID card for status of claims filed on an ADA form; do NOT call BCBSLA.
  • ADA claim forms received by BCBSLA for dental services will be sent back to the provider, advising the provider to file the claim to the plan named on the back of the member's ID card.
  • Providers should not expect payment from BCBSLA for ADA claims for BlueCard® members. The member or provider will get paid directly from the member's home plan or intermediary adjudicating the claim.

Using CMS-1500 and Electronic Claim Forms

  • Electronic claims received by BCBSLA for dental services provided to BlueCard® members will be returned to the provider to re-file the claim to the plan named on the member's ID card.
  • We recommend that dental providers and oral surgeons filing dental services that fall under the medical care category do so on a CMS-1500 claim form or submit electronically.
  • Services filed correctly on a 1500 claim form or professional electronic claim form will be processed by BCBSLA and sent to the plan named on the back of the member's ID card for adjudication under medical policy guidelines.This does not guarantee payment.
  • Services filed incorrectly or with missing information on a CMS-1500 claim form or professional electronic claim form will be returned to the provider for a corrected claim.
  • Dental claims submitted on a CMS-1500 claim form or professional electronic claim form may be processed through BlueCard:
    • Providers should expect the remit or payment to come from BCBSLA if the claim is processed to pay the provider.
    • If the claim is processed by the member's home plan to pay the member, the member will receive payment from the member's home plan and not from BCBSLA.
  • Providers should call BCBSLA for claim status inquiries for dental services filed on a CMS-1500 claim form or electronic claim form.