Most dentists submit claims directly to the insurers; therefore, you do not need to supply Dental claim forms to your members. If a claim is incurred outside your Province of residence, or inside the Province where the dentist has required payment from the member, a Standard Dental Claim form should be obtained from the dentist providing the service. These forms are available in all dental offices.
If a dental treatment is expected to exceed $500, a treatment plan (pre-authorization) should be submitted to the insurer prior to services being performed. The treatment plan itemizes what is covered by the insurer allowing the member to know exactly how much of the treatment is covered and how much they will have to pay. Treatment plans are assessed based on your plan design when the pre-authorization is received by GroupSource. If your group plan changes between the time the treatment plan is created and when service is rendered, and there is a reduction in benefits, the employee will be responsible for the cost of treatment.
Tip!
Claims should be submitted within 90 days after the end of the calendar year in which expenses were incurred. If coverage has been terminated, members have 90 days from their termination date to submit any eligible claims, or as defined in your Benefits Handbook(s).
Dental claims may be submitted on either the GroupSource standard dental claim form, or on a dental claim form generated by dental offices. For proper validation of coverage and payment, all dental claims must be signed by the Dentist and the member.
- Basic dental claims may be submitted via email, EDI, fax, mail, or the Mobile App.
- Pre-authorized Major and Orthodontic claims should be submitted with a Standard Dental Claim Form, via email, fax, or mail.
- Note: We recommend submitting Major and Orthodontic expenses over $500 for pre-authorization.