If you are not a dentist or dental office employee, explore our content for plan members and families, employers, or brokers and consultants.
If you are not a dentist or dental office employee, explore our content for plan members and families, employers, or brokers and consultants.
Claims process changes effective May 2024
Claims submission
Sun Life will require the Standard ADA Dental Claim Form (version 2006 or later, ©American Dental Association. All rights reserved.) for:
Payment schedule and explanation of benefits (EOB) format
Claims Address: New PO Boxes are coming in May!
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).
Certain information is needed to identify your patient. The following fields should be completed on your claim form:
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.
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).
#1341595137 04/24 (exp. 12/25)