Tips for avoiding delays with claims processing

We know how busy your practice can get. To ensure your dental claims are processed without unnecessary delays, we've compiled some tips to help with filling out key sections of the claim form. As a reminder, Sun Life requires the standard ADA Dental Claim Form* version 2006 or later for claims and pre-determinations. 

When submitting claims please make sure to fill out the following information:

Boxes 48-51 with the Billing Dentist or Dental Entity information:

  • Box 48: Make sure to enter the name and full address of the dentist or dental entity submitting the claim. This could be your practice, the treating dentist, or a group practice, depending on the structure.
  • Box 49: For the NPI (National Provider Identifier), include either a Type 1 (individual dentist) or Type 2 (group practice). If your practice is incorporated, make sure to list the Type 2 NPI. Unincorporated? Enter the treating dentist’s Type 1 NPI.
  • Box 51: Provide the 1) SSN or TIN if the billing dentist is unincorporated; 2) corporation TIN of the billing dentist or dental entity if the practice is incorporated; or 3) entity TIN when the billing entity is a group practice or clinic

Boxes 53 – 58 with the Treating Provider and Treatment Location Information (this is the provider who serviced the member and the location where the services were completed):

  • Box 54: Type 1 (individual dentist) NPI for the treating dentist
  • Box 55: Include the license number of the treating dentist. This might differ from the billing dentist, especially if a “locum tenens” dentist is filling in.
  • Box 56: Include the treating dentist address in this box if the billing entity is different than the treating dentist location

Taking the time to ensure these fields are completed will result in quicker claims processing. We truly appreciate your cooperation and the care you provide to our members.

Claims submission resources:

Below you will find some additional tips to help you when submitting claims. We also have a couple flyers that we have created for your reference. 

Claims Address: 

  • State of Florida members (group #A896): Sun Life, PO Box 1618, Milwaukee WI 53201-1618
  • New York members: Sun Life, PO Box 1428, Milwaukee WI 53201-1428
  • All other members (including other Florida groups): Sun Life, PO Box 311, Milwaukee WI 53201-0311

Electronic Payor ID:
70408

Review the guidelines to determine which attachments, if any, are required. In addition to the requirements, all claims must be submitted using an ADA Claim Form (2006 or newer) and must include a National Provider Identifier (NPI). 

  • You will receive a consolidated EOB that includes multiple claims on a weekly basis.
  • When you look at the member's record on the portal you will see the details for their single claim payment.

Certain information is needed to identify your patient. The following fields should be completed on your claim form:

  • Employee Name
  • Employee Date of Birth
  • ID Number
  • Patient Name
  • Patient Date of Birth
  • Group Name
  • Group ID Number

You can submit claims or attachments to us electronically through VYNE/NEA, VYNE/Tesia and DentalxChange.

The label on the x-ray should include the patient's name, date the x-ray was taken, tooth number(s) and the complete name and address of the treating dentist or dental practice.

Duplicate x-rays must be of good diagnostic quality. 

There is no need to submit a claim more than once. Whether you submitted your original claim online, electronically or through the mail, you can check the status online through our provider portal.

Invalid or incorrect codes may cause a delay in your claim payment. Use the most current American Dental Association (ADA) publication.

Include tooth number for the teeth involved in the procedure. When submitting a claim for a periodontal procedure that does not include a full quadrant, include specific tooth numbers. Also, remember to include the number(s) of other missing teeth in the same arch when submitting claims for Prosthodontics.

Include tooth surfaces for all restorative treatment. Make sure that tooth surfaces correspond with submitted CDT code.

When submitting claims for Prosthodontics or Crowns, indicate if treatment is initial placement or a replacement. If a replacement, include the date the original prosthetic or crown was placed.

Include full-time student information if your patient has exceeded the standard dependent age limit. Members may also call us with this information.

When Sun Life is the secondary payer, please provide the primary carrier's EOB with the submitted ADA claim form. Also, remember to include the primary carrier's member name, date of birth and relationship to the insured.

When submitting orthodontic claims, include treatment fee, banding date, estimated number of months in treatment and prior carrier information.

  • Capitation payments will continue to be monthly.
  • Claim payments release weekly on Friday.
  • Most electronic funds transfer (EFT) payments will process in 24-48 hours and most checks will process in 3-5 business days from the date of claim adjudication.

* ADA Claim form © American Dental Association. All rights reserved

Group insurance policies are underwritten by Sun Life Assurance Company of Canada (SLOC) (Wellesley Hills, MA) in all states, except New York. Prepaid dental products are provided and administered by SLOC and are provided by prepaid dental companies affiliated with SLOC, in certain states except New York. In New York, insurance products and prepaid dental products are underwritten or provided and administered by Sun Life and Health Insurance Company (U.S.) (SLHIC) (Lansing, MI). 

#1502143679 09/24 (exp. 09/26)