Submit Dental

To submit a dental bill:

Access this page using the method below that applies to you:
- WCMBP Users: In the Bills menu, click the Submit Dental hyperlink.
- Provider Portal Users: From the Provider Portal home page, select the On-line Bills Entry hyperlink. At the Online Bills Entry page, select the Submit Dental hyperlink.

The system displays the Dental Bill page.

Select the indicator from the Special Indicator drop-down.
Select the program from the Program drop-down list.
Under the Billing Provider Information heading, enter the billing provider ID in the Provider ID field, and select OWCP ID from the Type drop-down.

The remainder of the Provider Information section consists of expandable grids that each asks a Yes or No question. The grid expands to show additional fields to be filled in according to your answer.

Answer Yes or No to the following grid questions:

Is the Billing Provider also the Rendering Provider? – If you select No, the grid expands. Enter and select the rendering provider’s details in the Provider ID, Type, and Taxonomy Code fields.
Is the Billing Provider also the Supervising Provider? – If you select No, the grid expands. Enter and select the supervising provider details in the Provider ID and Type fields.
Is this service the result of a referral? – If select Yes, the grid expands. Enter and select the referring provider details in the Provider ID and Type fields.

In the Claimant Information section, enter the claimant ID in the Claimant ID field, and select Case Number from the Type drop-down.

The system automatically refreshes the section with the rest of the claimant information fields populated. You can make changes to these fields if needed.

If the bill has third-party liability, select Yes at the grid question, Does Bill have any Third Party Liability Amount? The grid expands so you can enter the amount in the Third Party Liability Amount field.
In the Bill Information section, at a minimum, enter or select values for the required fields.
Enter the prior authorization number in the Prior Authorization Number field, if applicable.
Expand the Delay Reason sub-heading to select the delay reason code.
Expand the Bill Note sub-heading to add a note to the bill.
Answer Yes or No to the grid question, Is this bill accident related? If you answer Yes, the grid expands so you can specify the causes from the Related Causes drop-downs and enter the date of the accident in the Accident Date field. If applicable, select the state where the auto accident occurred from the Auto Accident State drop-down.
Answer Yes or No to the grid question, Is this bill related to orthodontic services? If you answer Yes, the grid expands so you can enter the orthodontic treatment details. Expand the Tooth Status sub-heading to enter a tooth number and tooth status code. Select the Add Another hyperlink to add fields for additional tooth fields.
Answer Yes or No to the grid question, Does this bill require a diagnosis code? If you answer Yes, the grid expands so you can enter the diagnosis code category and up to four diagnosis codes.
In the Basic Line Item Information section, at a minimum, enter or select values for the required fields.
Expand the Tooth Information sub-heading so you can enter the tooth number or letter and specify the tooth surface category.
To add more service line information, expand the Additional Service Line Information sub-heading so you can specify the prothesis, crown, or inlay code and enter the placement dates.
When you are finished on the page, click the Add Service Line Item button.

The system updates the Dental Bill page and displays the submitted details in the Line Item Information list at the bottom of the page.

If necessary, click the Line No. hyperlink at the bottom of the page to make any changes to the line information and then click the Update Service Line Item button.
Select Submit Bill.

The system displays a pop-up message asking if you want to submit any backup documentation.

Select OK.

The system displays the Backup Documentation page.

Select Browse to select the file to be uploaded as backup.

Note that acceptable file types include only PDF, TIF, or TIFF.

Select OK.

The system displays the Submitted Dental Bill Details page with the newly generated TCN.

Select Submit to process the bill for adjudication.

The system displays a dialog message confirming the bill was submitted successfully.

Select OK to return to the Dental Bill page and add another bill.

View the newly generated bills in the Inquire Bills section.

In the Inquire Bills list page, click the TCN hyperlink for the bill that you want to view.

The system displays the bill with the updated Bill Status and the Processing Status as Edits Processed.

Submit Dental

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