You should confirm the specific benefits applicable to a patient by calling the GHI Provider Services Department. The use of ADA codes is designed to simplify and expedite the process of pre-determination. Emergency treatment is excluded from the pre-determination process. To assess benefit amounts, GHI will consider whether alternate procedures could be performed. These must be ADA accepted dental procedures.
Reimbursement is made according to the standard fee schedule.
If a treatment plan is not sent in advance to GHI for pre-determination, benefit amounts may be paid based on alternate procedures. This amount may be less than the amount for the actual services rendered. To receive benefits, you must complete and file a claim form. To ensure prompt adjudication, it is important that your submitted claims contain all the information required by GHI for processing. The following tips are provided to assist you in submitting claims.