Sun Life Financial, US

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Dental Plan FAQ's

Frequently asked questions (FAQ) for Providers:

Preferred Provider Organization (PPO) topics

Prepaid plan topics

Specialty benefits topics

Preferred Provider Organization (PPO) topics

About our PPO Networks

  1. What Preferred Provider Organization (PPO) Networks do you offer?
  2. How will I know when a patient participates in one of your PPO networks?
  3. How do I join your PPO networks?
  4. Is there a fee to join your PPO networks?
  5. How is the quality of the network assured?
  6. How do patients find out that I am a participating dentist?
  7. May I discontinue referrals?
  8. Who do I call with questions about my network participation?
  9. Who do I call if I have questions regarding my Personal Fee Profile?
  10. Who do I contact if I have questions regarding my responsibilities with your PPO Networks?

Dental Claims Administration

  1. How do I find out about coverage, deductibles, co-pays and maximums for your patients?
  2. Am I required to refer patients to specialists in a patient's PPO network?
  3. How do I submit a claim for one of your patients?
  4. What am I allowed to bill the patient when you apply the alternate benefit provision?
  5. Am I allowed to bill the patient if a service is not paid by you?
  6. Can I send electronic attachments?
  7. Can I check eligibility online?
  8. How do I sign up for electronic claims?
  9. Pre-estimate questions:
    A. How long does it take to process pre-estimates?
    B. What are the guidelines for submitting pre-estimates?
    C. Can I fax pre-estimates to you?
  10. If I have a problem with a claim from you, which number do I call?
  11. If I have a problem with a claim from another company that uses the DHA network, whom do I call?
  12. If I have a dispute with you, how can it get resolved?

Prepaid plan topics

General Provider Questions

  1. What is the Prepaid Dental Plan?
  2. How do I join the Prepaid Plan?
  3. What states are the Prepaid Dental Plans available in?

General Dentist Provider Questions

  1. How does the Prepaid Plan work?
  2. How do I know which plans I accept?
  3. How do I refer my patient to a specialist?
  4. How do I verify patient eligibility?
  5. Do plan members have to assign me as their Plan Dentist to receive benefits?
  6. Do I need to submit a claim?
  7. Can I file claims for the difference in copayments and costs?
  8. How do I know if I have the most current version of the plan Copayment Schedule(s)?
  9. What happens if the procedure I performed is not listed on the Copayment Schedule?
  10. How can I have a specialist, to whom I refer, added to the network?
  11. If I have a dispute with you, how can it get resolved?

Specialty benefits topics

Specialist Provider Questions

  1. Do I need a referral to see the patient?
  2. How do I know if a patient has the Specialty Benefit Amendment?
  3. How do I get reimbursed for services?
  4. What is the Specialty Benefit Amendment (SBA)?
  5. Do all patients have the SBA?
  6. How can I receive information about the SBA if I don't currently accept members with the SBA?
  7. If I do not wish to accept members with the SBA, what should I do?
  8. Where do I submit an SBA claim for the remaining contracted balance?