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Claims process changes effective May 2024

Claims submission

  • Electronic – Payor ID 70408
  • Online – Submit claims quickly and easily through the provider portal.
  • Mail – NEW PO Boxes are coming in May

Updated claim form

Sun Life will require the Standard ADA Dental Claim Form (version 2006 or later, ©American Dental Association. All rights reserved.) for:

  • Claims and pre-treatment estimates (PTE).
  • Information requested to complete a claim or PTE review.
  • Submission of services after a PTE.

Payment schedule and explanation of benefits (EOB) format 

  • If you receive EOBs for single claim payments, you will receive a consolidated EOB that includes multiple claims on a weekly basis.
  • The single claim payment version of the EOB will be available on the portal when you look at the member's record. 
  • Capitation payments will continue as they do today. 
  • Claim payments will continue to release weekly on Friday.
  • Most electronic funds transfer (EFT) payments will process in 24-48 hours and most checks will process in 3-5 business days from the date of claim adjudication.

Claims will no longer pend when all required information is not included

  • To ensure efficient claims processing, submit all required information electronically.
  • Claims submitted without appropriate diagnostic information will no longer pend for missing information and will not be processed. For example, single posterior crowns submitted with core buildup or multiple crowns will no longer pend if they do not include X-rays and narratives – they will be denied for lack of documentation.

Get our Claim Submission Tips flyer

Download the brochure

Claims Address: New PO Boxes are coming in May!
Sun Life
PO Box 2940
Clinton, IA 52733

Electronic Payor ID:
70408

Claim attachments are not always necessary. Review the guidelines to determine which attachments, if any, are required.

Certain information is needed to identify your patient. The following fields should be completed on your claim form:

  • Employee Name
  • Employee Date of Birth
  • ID Number
  • Patient Name
  • Patient Date of Birth
  • Group Name
  • Group ID Number

You can submit claims or attachments to us electronically through Vyne 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. Dental consultants, during professional claim review process, have difficulty in making an accurate benefit determination with duplicate x-rays of poor 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.

Please use the appropriate CDT codes. 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 payment amount.

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)