Dentist FAQ's

A:   If you are currently a contracted NDB Participating Provider and adding a new associate dentist to your practice, you may download a Nevada Credentialing Form here for the dentist to complete. Once completed, you may fax the form to NDB at (702) 852-0260, email to us at credentialing@primecarebenefits.com.

Please be sure to attach current copies of the following items: Nevada State Dental License (wallet-size copy with expiration date), DEA and NV Pharmacy Certificates, Declaration Page of Professional Liability Policy. Important: If any questions are marked “YES” under the “Practitioner Questionnaire”, a written narrative must be provided.

Any discrepancies between the answers provided in the Practitioner Questionnaire and the discovery of occurrences and/or actions through the credentialing process may result in disqualification of credentialing approval.

A:   If you are changing your Payee or Billing Entity information, such as your office’s EIN/TIN, please contact a Professional Networks Representative at (702) 478-2014. You will be asked to submit a W-9 and brief narrative stating the change you would like to make.

If you would like to update your office hours, languages spoken, demographic information or your office information that is displayed through NDB’s “Find a Dentist” web tool, you may download a Practice Profile form here. Please fax your completed form to NDB, Attention: Professional Networks at (702) 333-9140.

If you are planning to move your office to a new location, please contact a NDB Professional Networks Representative at (702) 478-2014. NDB Provider Agreements are based on location and may not transfer if you move your office to a new location.

A:   NDB Participating Providers have online access to verify a member’s eligibility and benefits 24 hours a day through NDB’s Online Provider Portal. Registration is required in order to gain access into this portal. Please contact NDB’s Customer Service department at (702) 478-2014 for assistance. When verifying eligibility and benefits, you will need the member’s ID, name and date of birth. Follow this link to be taken to NDB’s Provider Portal.

A:   NDB Participating Providers have online access to check the status of a claim or view claim history 24 hours a day through NDB’s Provider Portal. Registration is required in order to gain access into this portal. Please contact NDB’s Customer Service department at (702) 478-2014 for assistance. When checking the status of a member’s claim, you will need the member’s ID (SSN), name and date of birth. Follow this link to be taken to NDB’s Provider Portal.

A:   NDB receives claims in three (3) formats:

• Electronic Claims submitted through NDB’s Provider Portal
• Electronic claims submitted through clearinghouses utilizing the HIPAA compliant ANS X12 837D file format.
• Paper claims

Providers are encouraged to submit claims to NDB electronically. If you need assistance in registering with NDB’s Provider Portal in order to submit claims directly to NDB, please contact us at (702) 478-2014.

If you submit claims through a clearinghouse, NDB currently accepts electronic claims directly from the following clearinghouses: EDI Health Group, Inc. – DentalXchange, Vyne Dental and Change Healthcare. If you do not submit your claims through one of these clearinghouses, then your claim may be converted to a paper claim by your clearinghouse and mailed to NDB, which will take longer for NDB to receive your claim. Please keep this in mind when meeting NDB claim filing deadlines.

For NDB’s managed care plans, all claims must be received by NDB by the 5th of the month following the month when services were rendered. Example, claims with dates of service in January, must be received by February 5th in order to be considered for reimbursement.

A:   When NDB is the secondary insurance carrier, a copy of the (non-NDB) primary carrier’s Explanation of Benefits (EOB) or Remittance Advice must be submitted with the claim. NDB will consider the patient responsibility that is remaining, after the primary carrier has paid the claim, as the amount to be considered for benefit under the member’s secondary coverage.

NDB will allow up to the plan’s maximum allowance of benefits, minus any member copayment and/or deductible. Payment is not to exceed the patient’s responsibility after the primary carrier’s payment.

A:   When a member has coverage within two of the same plans administered by NDB, such as Culinary as primary and Culinary as secondary or UFCW as primary and UFCW as secondary, NDB’s claim processing system has the ability to automatically process payment for secondary benefits without requiring a secondary claim to be submitted by your office.

This process is usually initiated the day after the primary claim was processed. Therefore, you should receive the primary and secondary payment within a day or two of each other. This allows for faster payment to your office and eliminates the need for you to submit a separate secondary claim to us with a copy of the primary remittance/E.O.B.

When a member has coverage within two different plans, even though both plans are administered by NDB, this automated process is not available. Example, member has primary coverage under Culinary and secondary coverage under Bricklayers. Therefore, you will need to submit a secondary claim to NDB with a copy of the primary remittance/E.O.B.

A:   No, NDB Participating Providers agree to collect the designated in-network member copayment for the procedures performed or designated co-insurance according to the member’s plan design. Balance billing between your Usual & Customary Rate (UCR) and the plan payment is not allowed by a NDB Participating Provider.

A:   For NDB’s managed care plans, services must be submitted by the NDB Participating Provider within five (5) days from the date of service. NDB reserves the right to deny any procedures received over thirty (30) days from the date of service.

A:   Managed Care Plans – Pre-authorization for general dental services are not required. Pre-authorization for specialty services are required. In order for a member to receive in-network benefits at a specialist office, the member must be referred by a NDB Participating General Dentist Provider and the request for referral must be approved by NDB. Providers are required to complete a “NDB Request for Specialty Referral” form and submit to NDB for review. Specialty referral forms can be found here.

PPO Plans – Pre-authorization is required for treatment plans over $750.00 and for the following procedures: crowns, bridges, molar root canals, all root canal re-treatments and periodontal surgery.

A:   For members covered under a managed care plan, a NDB Participating General Dentist must complete a “NDB Request for Specialty Referral” form and submit to NDB for review. Follow the instructions for submission on the back of the form. Specialty referral forms can be found here.