Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind our dental providers of important best practices when submitting both electronic and paper claims.

We have recently seen an increase in claims submitted with missing or incorrect information. Incomplete or inaccurate claims can result in processing and payment delays, creating additional administrative work for both providers and Blue Cross NC. 

Common claim filing issues

We have identified the top issues that cause claims to be returned or delayed. Carefully review each claim to help minimize a delay in payment:  

• Incorrect or incomplete Member name not matching ID card
• Missing or incorrect Group Number
• Incorrect or incomplete Subscriber ID including Member Code

Best practices for dental claims submission

• Always ask for a copy of the most recent ID card. 
• Verify dental benefits before providing services.
• Submit claims electronically whenever possible. Filing electronically reduces expensive administrative tasks for your staff and improves the turnaround time for reimbursement to you.
• Use the exact information from the member’s ID card, including:
  • Full legal names. Avoid using nicknames or shortened names on claims. (e.g., submit “Katherine,” not “Kathy”; “Jonathan,” not “John”). Name must match what is on the ID card.
  • Correct dependent information.
• Ensure all required fields are completed accurately including: 
  • Group Number
  • Member ID (numeric values only including two-digit suffix)
  • Member / Patient Last Name
  • Member / Patient First Name
  • Member / Patient Date of Birth
  • Provider Name (as noted when Practice / Provider enrolled with Blue Cross NC)
  • Provider Address

Adherence to these best practices ensures a smoother, more efficient claims process benefiting your practice and the patients / members you serve.