Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating the dental claim filing/payment process for Orthodontia services covered by Dental Blue, Dental Blue Preferred and Dental Blue Select benefit plans. The following changes do not apply to any Pediatric Dental Claims filed against the Member’s Medical Insurance policy.
Effective July 1, 2025, all new dental claims related to the start of Orthodontic treatment will only need to be filed one time, at the start of care. Based on the claim and the treatment plan submitted, Blue Cross NC will pay the initial deposit of up to 30 percent, with the balance of the allowed amount or benefit maximum (whichever is greater) paid out monthly, over the course of treatment. All orthodontic, monthly maintenance fees will be automatically paid to the provider on the 1st of each month, until the lifetime maximum has been met. Should a monthly maintenance claim be filed, it will deny as a duplicate.
Orthodontic treatment that is in progress prior to July 1, 2025, will not be impacted. Dental claims will need to continue to be filed monthly, for the remainder of the treatment plan terms.
Should a member’s treatment plan change, or the member transfers to another dental provider, at any time during the course of treatment, the current dental practice is required to submit an updated treatment plan in writing, detailing the change. All claims, treatment plans and updates should be filed to the address found on the back of the member’s Dental ID card.
