Does ACS Benefit Services, Inc. require any special claim forms?
Yes, all Dental Claims not filed electronically should be filed on the current ADA Dental Claim Form. You may download a copy of this Claim Form from the Forms Library. It is pre addressed and has our Electronic Payer Id on it for your convenience. The Claim form should contain the Subscriber’s ID as it is printed on the Dental ID Card. All ACS Dental Plan Identification numbers begin with the letter “A”. Due to the potential risks associated with identity theft, ACS does not recommend the filing of Dental Claims with the subscriber’s Social Security Number (SSN). On January 1, 2009, ACS will begin to reject claims filed with anything other than the Subscriber’s ID as printed on their Dental Id Card. Each Service Line on the Dental Claim Form should clearly identify by CDT Code, services rendered, with tooth number, and surfaces where applicable, the Date of Service and a billed amount. The Rendering Provider and the Billing entity should also be clearly defined by Tax Id and NPI numbe
Yes, all Dental Claims not filed electronically should be filed on the current ADA Dental Claim Form. You may download a copy of this Claim Form from the Forms Library. It is pre addressed and has our Electronic Payer Id on it for your convenience. The Claim form should contain the Subscriber’s ID as it is printed on the Dental ID Card. Due to the potential risks associated with identity theft, ACS does not recommend the filing of Dental Claims with the subscriber’s Social Security Number (SSN). On January 1, 2009, ACS will begin to reject claims filed with anything other than the Subscriber’s ID as printed on their Dental Id Card. Each Service Line on the Dental Claim Form should clearly identify by CDT Code, services rendered, with tooth number, and surfaces where applicable, the Date of Service and a billed amount. The Rendering Provider and the Billing entity should also be clearly defined by Tax Id and NPI number.
