FOR PROVIDERS
The Principal Plan Dental Network
Provider Operations Guide
Table of Contents
Dental ID Card.................................................................... 2
Benefit eligibility and verification
Overview of Claim Procedures........................................... 3
Claim submission
Electronic claim submission
Electronic claim attachment
Predetermination
Supporting information for claims and predetermination
Electronic funds transfer – direct deposit
Billing and Provider Payment............................................ 5
Claim payment and billing
Claim payment status or questions
Member questions
Coordination of Benefits
Notification of office changes
Utilization Review.............................................................. 6
Benefit Eligibility and Verification - Online or By Phone... 7
Online
How to sign up
Save time by accessing benefits by fax or email
Need a copy of an Explanation of Benefits (EOB)?
Principal Dental Access Network........................................ 9
Discounted Products and Services..................................... 9
Special Programs.............................................................. 12
Supporting Claim Guidelines................... Inside Back Cover
This publication is intended to provide accurate and authoritative information in regard to the subject matter covered. The accuracy of
the information is not guaranteed and is provided with the understanding that Principal Life is not rendering legal, accounting, or tax
advice. While this communication may be used to promote or market a transaction or an idea that is discussed in the publication, it is
not a marketed opinion and may not be used to avoid penalties under the Internal Revenue Code. You should always consult with
appropriate counsel or other advisors on all matters pertaining to legal, tax, or accounting obligations and requirements.
Welcome to the
Principal Plan Dental Network
Principal Life Insurance Company welcomes you to the Principal Plan® Dental Network. We are excited to work
with you and your practice, and look forward to helping you serve our members covered by dental insurance
from Principal Life. It takes quality providers like you to keep our network strong and our members covered.
This guide will help you in your day-to-day operations as a participating provider in our network.
Please contact us with questions:
Principal Plan Dental Network
Attn: Provider Relations
711 High Street
Des Moines, IA 50392-2556
800-832-4450
Hours: 7 a.m. to 7 p.m. CST
www.principal.com
1
Dental ID Card
When our insured members visit your office, please review their Principal Life dental ID card. As shown on the
sample card below, you will find the employer’s name and account number, patient and dependent names,
verification of the network, a benefit verification phone number and an address to submit claims.
Insured members can also provide a copy of their dental ID card via the Principal Mobile® application. The app
is free and can be downloaded to Apple® iPhones/iPads or AndroidTM phones or tablets.
Depending on coverage, you could see either of these cards:
Patient ID number - Refer to this
number when submitting claims.
FRONT
Payor number: Refer to this number
when submitting claims electronically.
Employer name
FRONT
Employer policy or
account number
Patient name and
dependents
Verification of
the Principal Plan
Dental Network
Benefit and
eligibility verification
phone number
BACK
BACK
Mailing address
for claims
2
Overview of Claim Procedures
Claim submission
Your office is responsible for submitting all claim forms. Please bill your normal charge.
Claims may be submitted using the following:
• Electronic claim submission
• ADA standard claim form
Claim forms must contain the following information (items in bold can be found on the patient’s ID card):
• Patient Name
• Date of Service
• Patient Date of Birth
• Procedure(s) using current ADA Codes
• Employee Name and Address
• Billed charge
• Employee ID Number
• Clinical Diagnosis and X-rays (if applicable)
• Employer Name and Policy or Account Number
• Other Insurance
If mailing the claim form, send it to the address found on the back of the ID card.
Electronic claims submission
Principal Life has been receiving claims via Electronic Data Interchange (EDI) since 1982. EDI is an efficient,
cost-effective way of filing claims. If you have the capability to file claims electronically or are interested in
doing so with Principal Life, we have clearinghouses available for receiving claims electronically.
Call or visit them online:
• Emdeon: www.emdeon.com or 877-363-3666
• Capario: www.capario.com or 800-586-6870
• Tesia: www.tesia.com or 800-724-7240 x4, or Renaissance Systems Services LLC: www.RSS-LLC.com or
866-712-9584
The Principal Financial Group payer number is 61271.
Electronic claim attachment
Principal Life utilizes the services of National Electronic Attachment, Inc. (NEA) and Tesia Clearinghouse, an
RHSC Company (Renaissance System and Service, LLC), for electronically submitted attachments for claim
processing purposes.
NEA’s FastAttach™ system allows dental providers to submit claim attachments to NEA’s secure website,
including:
• X-rays
• Perio charts
• Intra-oral pictures
3
• Narratives
Principal Life can then access them online for our claims adjudication process.
To learn more about NEA’s dental services, visit www.nea-fast.com.
Tesia Clearinghouse, an RHSC Company (Renaissance System and Service, LLC), offers the electronic submission
of attachments with dental claims. The secure eAttachment service offered through Tesia allows providers to
efficiently transmit X-rays and any documentation required by payers to determine the benefit on a dental claim. To learn more about these services, please contact Tesia at 800-795-7320 or www.tesia.com or Renaissance
Systems Services, LLC at 866-712-9584 or [email protected].
Predetermination
Before treatment begins for services such as inlays, onlays, single crowns, prosthetics, periodontics and oral
surgery, you may file a dental treatment plan with Principal Life. Principal Life will provide a written response
indicating benefits that may be payable for the proposed treatment. We strive to respond to predetermination
requests within 30 days. Predeterminations can be submitted electronically.
The dental treatment plan can be submitted electronically or sent to the claim center listed on the patient’s
dental ID card. The plan should contain:
• Procedure(s) using current ADA codes
• Dental necessity
• Billed charge
• Supporting X-rays/information
Supporting information for claims and predetermination
For your convenience, a tear-out reference of Supporting Claim Guidelines is located on the inside of the
back cover.
Electronic funds transfer – direct deposit
You can receive claims payments faster, reduce accounting expenses and improve cash flow with electronic
fund transfer and electronic remittance advice services provided by PaySpan Health.
For more information, contact PaySpan client support center toll-free at 877-331-7154 or visit
www.payspanhealth.com to register.
4
Billing and Provider Payment
Claim payment and billing
Payment for claims from Principal Life includes an explanation of benefits (EOB). The EOB indicates any
adjustments to charges you will need to make to your records. It will also indicate the amount due from the
patient, if any. Examples of amounts due by the patient would be coinsurance or deductibles. See a sample
EOB below.
Charges greater than the contracted payment cannot be balance billed to the patient. Patients can be billed
Claim
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Claim
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Maximum allowances for orthodontic procedures will be based on a 15% discount off billed charges. Charges
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treatment as needed, debanding, retention appliances (first set), and follow-up retention visits.
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5
Claim payment status or questions
You can view claim status and reimbursements at www.principal.com. Or you can call the benefit verification
toll-free phone number at 800-247-4695.
Member questions
If a patient has a benefit-related question, please refer them to their personal login at www.principal.com or
the benefit verification toll-free phone number at 800-247-4695.
Coordination of Benefits (COB)
A coordination of benefits is used to determine if the Principal Life dental policy is primary or secondary.
• If the Principal Life dental coverage is primary, we will pay the full amount of benefits available under
the policy.
• If Principal Life dental coverage is secondary, benefits will be determined by the primary plan. The benefit
amount payable by the Principal Life dental policy may be reduced.
Notification of office changes
Principal Life’s Provider Relations team is available to assist you with:
• New associates
• Tax ID Number changes
• Address changes
• Requests for fee schedules
Timely notification of office changes helps ensure accurate and efficient claim handling. Call 800-832-4450 to
reach a member of the team.
Utilization Review
Utilization review is a required part of the provider recredentialing process. A statistically based utilization
system is used to profile dentists’ treatment patterns. Dentists whose practice patterns fall outside the
guidelines or who fail to comply may not be allowed to continue participation in the Principal Plan Dental PPO.
Principal Life recognizes that the design and implementation of a utilization review system is necessary for the
cost-effective delivery of quality dental care and the financial integrity of the insurers’ dental benefits. A dentist
must agree to the utilization review and to undertake cost-effective dental care consistent with accepted dental
practices.
The credentialing and recredentialing process has established utilization norms for certain procedure codes
against which the provider’s practice profile will be measured. If the profile meets the guidelines, the provider
will be allowed to continue participation in the Principal Plan Dental PPO. If the profile does not meet the
guidelines, the provider may be counseled regarding changes, which would allow him/her to be reconsidered.
6
Benefit eligibility and verification
online or by phone
Patient benefits may vary, so please confirm each patient’s eligibility for coverage and specific benefits. You can
use the Principal Provider Service Center on www.principal.com or call the benefit verification toll-free phone
number at 800-247-4695.
Online
You can view online insurance information for patients covered by group dental insurance from Principal Life.
The Principal Provider Service Center gives you and your staff convenient access to:
Benefits, Eligibility and Effective Dates – Check patient eligibility and coverage, including copays,
deductibles, benefit maximums, tooth history, network membership and benefits in effect on a given date.
Claim Status – View information about claims in process and claims processed/paid, including submitted
charge amounts, check issue dates and payment amounts.
How to sign up
Follow these steps to register for the Principal Provider Service Center. For registration assistance, call
800-621-6280.
1. Go to www.principal.com and select Provider Services from the Log In box.
2. Click Register Now.
3. Enter your federal Tax Identification Number.
4. The Register Here page continues with fields to enter Primary Security Administrator (PSA) information.
This is the person responsible for managing your account and granting access to other staff members –
usually the office or billing manager.
5. After you register, a username and temporary password will be provided.
6. Log in using your temporary password. You will be asked to establish a new password.
7. After the registration process is complete, your Benefit and Claim information is available. The PSA can
then grant access to secondary administrators – the office staff members responsible for checking patients’
benefits and claim status.
7
Save time by accessing benefits by fax or email
More detailed dental patient benefit information is available by request from Principal Life. Now you can
receive in-depth information by fax or email.
The Benefits & Eligibility fax or email contains a breakdown of dental benefits, including:
• Units of coverage
• Waiting periods
• Frequencies
• Detailed history
• Age limits
• Common limitations
Log in to Provider Services on www.principal.com and visit the Benefits & Eligibility tab for detailed
information about what is included in the fax or email. Or call 800-247-4695, select provider of service and
follow the automated prompts.
Need a copy of an Explanation of Benefits (EOB)?
Online
Log in to Provider Services on www.principal.com.
Phone
Call 800-247-4695. You will be taken into our automated voice response system. Self-serve options include:
• Request fax or email (after initial set up)
• Claims information
• Coverage effective date
• Mailing address
• Payor number
• Speak to a member service representative
8
Principal Dental Access Network
The Principal Dental Access NetworkSM* gives you another way to attract new and retain existing patients
lacking dental coverage. This program is not insurance, so there are no waiting periods, deductibles, claim
forms, annual maximums, exclusions or limitations, except for work in progress.
Eligible members pay you directly based on your current fee schedule. An eligible member’s ID card has a
Principal Dental Access Network logo like this example:
Member ID#
Member Name
you save
Effective Date
you smile
powered by:
Possession of this card is not
a guarantee of eligibility
(outside CA, AZ, NV)
This is a great opportunity to grow and maintain your customer base. However, if you want to opt out of the
Principal Dental Access program, send an email to [email protected] within 30 days of receiving
your welcome kit. Opting out of this network will not affect your participation in other networks.
*The Principal Dental Access Network is NOT insurance. It is not available in California and Arizona. Nevada providers
access this program through Diversified Dental Services. California and Arizona providers access this program through the
First Dental Health ACCESS Network.
Discounted Products and Services
As a valued participating dental office who serves our members, you have access to discounts on products
and services through our website – saving you time and money!
401(k)
Get an edge on retirement planning. Plan your own financial future while giving your
employees something to smile about – the opportunity to plan for their future at the same
time. The Principal Financial Group® is offering significant savings when you set up a 401(k)
retirement plan for yourself and for your staff members.
When you establish a 401(k) retirement plan with The Principal®, we will waive the application fee, a savings of
up to $1,000. To learn more, visit www.principal.com/dentist401k.
9
Claim payment by electronic funds transfer
Sign up now to receive electronic funds transfers (EFTs) and electronic remittance
advices (ERAs) through nationally known payment and remittance administrator
PaySpan Health. Signing up allows you to receive your claim payments through EFT
and claim details through ERA. Taking advantage of these options will help you receive claim payments faster,
reduce accounting expenses and improve cash flow.
There is no fee for this service. It’s easy for you to get started right away and register with PaySpan Health.
Setting aside five to 10 minutes now can make a huge difference in how quickly you receive your payments.
To register today, call PaySpan Health toll-free at 877-331-7154 and talk to a PaySpan representative.
Training for dental office staff
DrBicuspid.com is a free website designed specifically for dental professionals and team
members. Principal Life is working with DrBicuspid.com to provide participating dental
offices with free mandated OSHA training for the entire staff.
This training fulfills the annual Bloodborne Pathogen Standard education requirement. This course, valued at
up to $500, is offered free to Principal Life participating dentists.
Participating dental offices will also receive a 20% discount on any other course in the online continuing
education (CE) library.
The promotion code for the free course package “OSHA Dental Compliance Training” (which includes “The
Introduction to Bloodborne Pathogens”) is 853. The promotion code for 20% off all other courses is 854. To sign up for CE courses, register at DrBicuspid.com.
To learn more, visit www.principal.com/providerdiscounts
10
FastAttach and FastLook
Principal Life and National Electronic Attachment, Inc. (NEA), have worked together
for several years to offer the FastAttachTM system. FastAttach expedites the
transmission and review of important documentation, including X-rays, EOBs and
perio charts, in support of electronic claims processing.
But FastAttach is more than just an electronic attachment transmission service. It is a way to manage your
attachments. Instead of spending time sending unnecessary attachments, you can use a unique feature of
FastAttach called FastLookTM. This feature provides you with the attachment requirements for all procedure
codes for each payor.
The attachments transmitted using FastAttach will automatically create a tracking number, which provides
confirmation of receipt and a tracking mechanism for those attachments. All transmitted attachments can be
viewed online in the patient attachment history via any computer with Internet access. You can even securely
share attachments with other dental offices within HIPAA regulations.
NEA provides FastAttach and FastLook training and unlimited customer service at no additional charge.
To learn more about NEA’s dental services, go to www.nea-fast.com. From there, you can:
• Browse the NEA website for additional information
• View videos by clicking Learn More
• Register online by clicking Provider Registration If you prefer to talk to an NEA representative, call 800-782-5150, option 2.
Biological testing kits
Monitoring your instrument sterilization equipment can provide peace of mind in your
NORTH BAY/BIOSCIENCE, LLC
ability to protect against infection. Receive discounts on biological (spore) testing kits
and other products from North Bay/Bioscience, LLC, a leader in providing sterilizer
monitoring services to healthcare professionals.
To obtain your Principal Life participating dentist discount, please contact North Bay/Bioscience, LLC, at 800289-7786 and mention that you are a Principal Plan Dental participating dentist. To order online, visit www.
nbbs.com and enter code PRINCIPAL at checkout to receive your savings.
To learn more, visit www.principal.com/providerdiscounts
Insurance products and plan administrative services are provided by Principal Life Insurance Company. Securities are offered through Principal Securities, Inc.,
800-547-7754, member SIPC and/or independent broker dealers. Securities sold by a Principal Securities Registered Representative are offered through Principal
Securities. Principal Life and Principal Securities are members of the Principal Financial Group®, Des Moines, IA 50392.
Before investing in mutual funds, investors should carefully consider the investment objectives, risks, charges and expenses of the funds. This and other
information is contained in the free prospectus, which can be obtained from your local representative. Please read the prospectus carefully before investing.
Principal Life has arranged to make these discounts, products and services available to Principal Plan Dental Network providers. These arrangements do
not constitute an endorsement of any vendor, product or service offered. Availability of these offers is subject to change without notice. Principal Life and its
affiliates are not liable for product defects, provider negligence or other errors in the delivery of products or services. Access to the discounts included in the
Provider Discounts website does not constitute an endorsement of any vendor, product or service offered. All vendors are independent entities and are not
employees, agents or participating providers of Principal Life Insurance Company.
11
Special Programs
Periodontal Program – Principal Life’s periodontal
Principal Life Insurance Company
Periodontal Program Voucher
Principal Life Insurance Company is committed to helping you stay healthy. This periodontal voucher is just one of the ways we are helping
patients who are pregnant, or have diabetes or heart disease receive the extra care needed to maintain good oral and overall health.
program helps members who are pregnant, or have
diabetes or heart disease receive extra dental care.
Benefits – Scaling and root planing covered at 100% of covered charges (if deemed dentally necessary). If scaling and root planing
are not necessary, one additional routine cleaning or periodontal cleaning is offered (subject to deductible, coinsurance and
Benefits: Scaling and root planing covered
frequency limits).
Conditions – Only patients who are pregnant, or have diabetes or heart disease can use this voucher.*
CondItIon(s)
Date of Service
Patient Name
Provider Signature
servICe(s) Performed
Pregnancy
Routine cleaning
Diabetes
Periodontal cleaning
Heart disease
Scaling and root planing
How to submit – For correct claim processing of these additional benefits, this voucher and claim form must be submitted
through the mail. Send this complete voucher and claim form to:
at 100% of covered charges (if deemed dentally
necessary). If scaling and root planing are not
Principal Life Insurance Company
necessary, one additional routine cleaning
P.O. Box 10357
Des Moines, IA 50306-0357
A healthy smile means a healthy you. Talk to your dental provider today about preventive periodontal care.
or periodontal cleaning is offered (subject to
deductible, coinsurance and frequency limits).
We’LL gIVe you An edge®
Principal Life Insurance Company, Des Moines, Iowa 50392-0002, www.principal.com
*Other conditions may apply in Connecticut. See your booklet for more information.
GP54703-04 | 02/2013 | © 2013 Principal Financial Services, Inc.
Cancer Treatment Oral Health Program –
Principal Life Insurance Company
This program helps Principal Life members
Cancer Treatment Oral Health Program
undergoing chemotherapy and/or head/neck
Principal Life Insurance Company is committed to helping you during times of need. This program allows Principal Life members
undergoing chemotherapy or head/neck radiation therapy to receive extra dental care necessary to maintain good oral and overall health.
Benefits – Patients are eligible to receive up to three fluoride treatments every calendar year at 100% of covered charges and one
radiation receive extra dental care.
additional routine cleaning per calendar year. The fluoride treatments must be administered at the time of a scheduled cleaning.
Conditions – Only patients who have cancer and are receiving chemotherapy or head/neck radiation therapy can utilize this program.
CondItIon(s)
Date of Service
Benefits: Up to three fluoride treatments every
Patient Name
servICe(s) Performed
Chemotherapy
Routine cleaning
Head/Neck Radiation
Fluoride Treatment
Provider Signature
calendar year at 100% of covered charges and
How to submit – For correct claim processing of these additional benefits, this voucher and claim form must be submitted
through the mail. Send this complete voucher and claim to:
Principal Life Insurance Company
one additional routine cleaning per calendar
P.O. Box 10357
Des Moines, IA 50306-0357
year. Fluoride treatments must be administered
at the time of a scheduled cleaning.
We’LL gIve yOu an edge®
Principal Life Insurance Company, Des Moines, Iowa 50392-0002, www.principal.com
GP56131-03 | 02/2013 | © 2013 Principal Financial Services, Inc.
Second Opinion Program Voucher
To ensure you receive the best advice to make informed decisions about your dental care, Principal Life Insurance Company
covers second opinions from dental providers. Seeking appropriate care and second opinions from qualified providers helps
you get the most out of your dental benefits.
Typical reasons for second opinions*
Root canals
Tooth extractions
Orthodontia
Implants
Replacement fillings
Crowns and bridges
Oral surgery
TMJ treatment
Second Opinion Program – To ensure members
receive the best advice to make informed decisions
about dental care, Principal Life covers second
opinions from dental providers.
Benefits – The visit will be covered at 100%. This voucher makes it easier for Principal Life to identify which services are
second opinions.
Benefits: The second opinion visit will be covered
Date of Service
Patient Name
at 100%.
Provider Signature
How to submit – For correct claim processing of these additional benefits, this voucher and claim form must be submitted
through the mail. Send this complete voucher and claim to:
principal life insurance company
P.O. Box 10357
Des Moines, IA 50306-0357
*Subject to your benefit provisions.
We’ll giVe yOu an edge®
Principal Life Insurance Company, Des Moines, Iowa 50392-0002, www.principal.com
This is not a guarantee of benefits under your Principal Life dental policy. Claims will be paid according to the
terms of the group policy in effect at the time of service.
GP59830-02 | 08/2013 | © 2013 Principal Financial Services, Inc.
To obtain a program voucher, visit www.principal.com/providerdiscounts
12
Principal Life Insurance Company
Supporting Claim / Pre-Determination Guidelines
Use these general guidelines for frequently submitted procedures that require supporting claim information and/or
documentation to process the claim. Additional documentation may be required on a case-by-case basis.
Dental Procedure Code(s)
Current Pre-op X-Ray or Photo
Additional Supporting Material
D2140-D2161, D2391-D2394 (multiple posterior teeth)
BW x-ray(s)
Clinical diagnosis for each tooth
D2330-D2335, D2390 (multiple anterior teeth)
PA x-ray(s)
Clinical diagnosis for each tooth
PA or BW x-ray(s)
If replacement: Date of prior placement and clinical narrative
PA or BW x-ray(s)
If replacement: Date of prior placement and clinical narrative
PA x-ray(s)
Narrative
D4210-D4212, D4240-D4264
PA or BW x-ray(s)
Perio charting and past perio history
D4270, D4273, D4275-D4278
Photo
A chart or narrative containing the following Mucogingival Data
• Tooth # ____
• MM Recession ____
• MM Attached Gingiva ____
D4274
PA or BW x-rays(s)
Perio charting
D4341, D4342
FMX or Pano
Perio charting
RESTORATIONS
ONLAYS/CROWNS
D2542-D2544, D2642-D2644, D2662-D2664, D2710-D2794
CROWN BUILD-UPS
D2950
ENDODONTICS
D3331-D3333
PERIODONTICS
D4910
List past perio treatments and treatment dates
COMPLETE AND PARTIAL DENTURES
D5110-D5281
If initial placement:
Extraction date of teeth to be replaced
If replacement:
Date of most recent placement and clinical narrative
IMPLANTS
D6010, D6013-D6050
FMX or Pano
• Extraction date of teeth to be replaced
• List of missing teeth
• If replacement: Date of prior prosthetic and clinical narrative
D6058-D6077, D6094, D6110-D6117, D6194
FMX or Pano
• Extraction date of teeth to be replaced
• List of missing teeth
• If replacement: Date of prior prosthetic and clinical narrative
D6101-D6104
PA or BW x-ray(s)
Perio charting
FMX or Pano
• Extraction date of teeth to be replaced
• List of missing teeth
• If replacement: Date of prior prosthetic and clinical narrative
BRIDGES
D6205-D6252, D6545-D6794
ORAL SURGERY
D7210-D7240, D7250
PA and/or Pano
D7241
PA and/or Pano
• Pathology report
• Location of lesion
D7285, D7286, D7288, D7410-D7415, D7440-D7461
D7310-D7321
Narrative
PA and/or Pano
MISCELLANEOUS
D9940
Diagnosis of condition
WE’LL GIVE YOU AN EDGE®
Principal Life Insurance Company, Des Moines, Iowa 50392-0002, www.principal.com
Current Dental Terminology, © 2014 American Dental Association. All rights reserved.
This list is not all inclusive. There may be other dental procedures not listed that also require supporting documentation.
Dentists are requested to submit x-rays used for diagnosis and treatment planning when submitting claims for certain services. The x-rays should be
of diagnostic quality, mounted and identified with the dentist’s name and address, as well as the patient’s name. Also include the date the x-rays were
taken. If a copy of the x-rays is submitted, left or right should be indicated on the copy.
GP58750A-04 | 11/2014 | © 2014 Principal Financial Services, Inc.
WE’LL GIVE YOU AN EDGE®
Principal Life Insurance Company, Des Moines, Iowa 50392-0001, www.principal.com
GP51645-10 | 09/2015 | © 2015 Principal Financial Services, Inc.