Dental

Dental Provider FAQs

Accessing the Provider Portal

The provider portal can be accessed online at EnvolveDental.com/Logon.

Registering and requesting access to the portal

• You can request access on the Envolve provider resources page by clicking “request portal access.”
• Register as a Provider – Only see the provider’s claims and authorizations for one provider.
• Register as a Location – Only see the location’s claims and authorizations for one location.
• Register as a Payee – Access to ALL providers and locations associated with payee (tax ID #). Payee registration is recommended, as this will allow you to view your weekly EOPs.
  

What can you do on the provider portal?

• Submit Claims and Authorizations.
• Submit Corrected Claims.
• Check on Status of Claims and Authorizations
• Check member eligibility.
• Review EOPs (if registered as a Payee).
• Access provider bulletins, provider manuals, and other important communications and documents.

Dental Code Search Tool

The dental code search tool provides useful information such as:

• Is the procedure covered?
• Is a prior authorization required?
• Is there pre-payment review?
• Links to age and frequency limitations and other information regarding services.

Claims

Claims can be submitted three ways:

• Envolve Provider Portal
• Paper Claims
  • Must be submitted on a current ADA claim form
  • Cannot be handwritten
  • Mail to: Envolve Dental, PO Box 25974, Tampa, FL 33622-5974
• Electronically through a clearing house - Payor ID: 46278

Prior Authorizations

Authorizations can be submitted three ways:

• Envolve Provider Portal
• Paper
  • Must be submitted on a current ADA claim form
  • Cannot be handwritten
  • Mail to: Envolve Dental, PO Box 25974, Tampa, FL 33622-5974
• Electronically through a clearing house - Payor ID: 46278

What should be included with a prior authorization?

• Supporting documentation per clinical criteria or policy requirements (see dental code search tool for requirements)
• X-rays (if applicable)
• Periodontal charting (if applicable)
• Always refer to the dental code search tool to confirm if a prior authorization is needed or if a service is covered

FQHC/IHS/RHC Service Billing Guidelines

T1015 MUST be submitted with a dollar amount on the first line of the claim¹.

• Reimbursement will be based on the provider’s set encounter rate, regardless of the dollar amount submitted.
• All additional procedure codes describing services rendered should be submitted with a dollar amount of $1.00 or greater.

T1015 will be reimbursed at the encounter rate, provided services rendered include Medicaid covered procedures and the member is eligible at the date of service. Modifiers added to billed lines of T1015 will not be utilized by us but will have no impact on receiving payment. Please use these Place of Service codes: 50 for FQHCs; 72 for Rural Health Services; and 05-08 for Indian Health Services/Tribal Services.

¹Nebraska Department of Health and Human Services Manual Letter #61-2017 (PDF), 10/5/2017, pages 3 and 6.

Ambulatory Surgery Center, Ambulatory Surgery Unit Hospital Service Billing Guide

• Services performed in an ASC/ASU setting will not receive an encounter payment.
• Claims should indicate the CDT code performed with the appropriate dollar amount for that code.
• Please make sure that you are using the correct service location address via the web portal, clearinghouse or when sending via a paper claim.
• Place of service noted should be 22 or 24.

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