Provider Frequently Asked Question

You may click on a topic to go to that section or click on individual questions.

Provider Customer Service

1.  What are your customer service hours?

2.  Where can I check on claim status or participant eligibility?

3.  How do I obtain provider access to claim information on your web site?

4.  Where can I get a summary of benefits?

5.  Does ACS Benefit Services, Inc. have any special requirements for use of the National Provider Identifier (NPI)?

Preferred Provider Networks

1.  Does ACS Benefit Services, Inc. utilize a Preferred Provider Network?

2.  How can I join the Preferred Provider Network?

Claims and Payment Remittance

1.  How can I get help with understanding the Patient EOB or the Payment Remittance I received?

2.  What can I do if I have a question about a payment or wish to appeal an adverse benefit determination?

3.  Does ACS Benefit Services, Inc. require any special claim forms?

4.  What is the claim mailing address?

5.  How can providers submit claims electronically to ACS Benefit Services Inc.?

Pre-certification and Pre-authorization

1.  What is pre-authorization and when is it required?

1099 Reporting and W9 Requirements

1.  Does ACS Benefit Services, Inc. send 1099 information to the IRS for payments made to specific providers?

2.  How often do I have to submit a W9 to ACS Benefit Services, Inc. ?

Provider Customer Service

1.  What are your customer service hours? [Top]

You may call the toll-free customer service number on the participant's ID card Monday through Friday between the hours of 8:30 a.m. and 5:00 p.m. Eastern Time and speak with a customer service representative.

2.  Where can I check on claim status or participant eligibility? [Top]

You can check on claim status or participant eligibility on our web site, or you can call ACS Benefit Services, Inc.'s Customer Service Department. In order to check claim status on our web site, you must first register as a provider and obtain security access.

Please note: A summary of benefits and/or eligibility is not a guarantee of payment. Benefit determinations will be based on eligibility and plan limits at the time services are rendered. Benefits information only applies to procedures and diagnoses that are covered by the plan. We encourage you to review the SPD, Summary Plan Description, to determine if the charges in question are covered expenses. Pre-authorization requests for a specific diagnosis or procedure must be submitted in writing. If your request is by phone please provide your Fax number so the package can be faxed to your office.

3.  How do I obtain provider access to claims information on your web site? [Top]

You are required to register to the web site. You may register by going to the V2 Benefits Web Portal. Click the Register button. Under Sign Up for Your New Account, select Provider from the drop down menu, click Next. Enter your Personal Information, click Next. Create your User Name, Password, Security question and Answer. Once finished, click Create User. Sign into the Web Portal using the User Name and Password you just created.

Once you are signed into the Web Portal, you must request access to the payer's system in order to begin work with the payer. To do this, go to the payer Access tab, select a Payer (ACS Benefit Services), and then click Submit Request. Once the request has been approved, the provider can then begin making inquires and submitting claims,

4.  Where can I get a summary of benefits? [Top]

You may call ACS Benefit Services, Inc.'s Customer Service Department for assistance. Most employers distribute a benefits booklet, also known as a Summary Plan Description, directly to their employees. Summary Plan Descriptions are not available for distribution to the provider community. The benefits available vary by employer.

5.  Does ACS Benefit Services, Inc. have any special requirements for use of the National Provider Identifier (NPI)? [Top]

Beginning on May 23, 2008 ACS Benefit Services, Inc. will require all claims presented via EDI to include Billing and Rendering NPI numbers.

Preferred Provider Networks

1.  Does ACS Benefit Services, Inc. utilize a Preferred Provider Network? [Top]

ACS Benefit Services, Inc. has contracted with the DenteMax Network for some of our Clients.  The Member’s Dental ID card will display the Logo if they are covered by the DenteMax Network.

2.  How can I join the Preferred Provider Network? [Top]

You can learn about joining the DenteMax Network at the DenteMax web site.

Claims and Provider Remittance

1.  How can I get help with understanding the Patient EOB or the Payment Remittance I received? [Top]

You can contact our customer service department or you can review the Remittance Explanation and Understanding your EOB on this web site.

2.  What do I do if I have a question about a payment or wish to appeal an adverse benefit determination? [Top]

Please contact ACS Benefit Services, Inc.'s Customer Service Department for assistance. See Contact Us on this web site.

3.  Does ACS Benefit Services, Inc. require any special claim forms? [Top]

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.

4.  What is the claim mailing address? [Top]

On the ACS Benefit Services, Inc. web site, click "Contact Us" and it will provide you with the mailing address for submitting claims.  You should always check the Subscriber’s ID card to make sure claims should be mailed direct to ACS Benefit Services, Inc. and not to another address.

5.  How can providers submit claims electronically to ACS Benefit Services, Inc.? [Top]

ACS Benefit Services, Inc. currently receives both 837D claims electronically from Emdeon (formerly WebMD/Envoy/NEIC). ACS Benefit Services, Inc.'s Payor ID for submitting electronic claims is 61474. Providers can contact their software vendors to determine if they can submit claims electronically to ACS Benefit Services, Inc. The cardholder’s identification number as printed on the identification card must be provided on all claim submissions. Do not use the participant’s social security number to submit electronic claims.

Pre-certification and Pre-authorization

1.  What is pre-authorization and when is it required? [Top]

A pre-authorization is a request made prior to a procedure to verify benefits and medical appropriateness of the procedure. This allows the patient to make an informed decision of potential coverage for the procedure in advance. If you are unsure about whether a service or procedure should be pre-authorized, contact a customer service representative for more information.

Please note: A summary of benefits and/or eligibility is not a guarantee of payment. Benefit determinations will be based on eligibility and plan limits at the time services are rendered. Benefits information only applies to procedures and diagnoses that are covered by the plan. We encourage you to review the SPD, Summary Plan Description, to determine if the charges in question are covered expenses. Pre-authorization requests for a specific diagnosis or procedure must be submitted in writing.

1099 Reporting and W9 Requirements

1.  Does ACS Benefit Services, Inc. send 1099 information to the IRS for payments made to specific providers? [Top]

Yes, ACS Benefit Services, Inc. electronically submits annual payment information to the IRS.

2.  How often do I have to submit a W9 to ACS Benefit Services, Inc.? [Top]

An IRS Form W9 is required to be submitted as requested for the registration process, or when you file your first claim with ACS, or as the result of an IRS action due to a CP2100 report.  Failure to provide a W9 or certified W9 when requested may result in an IRS required withhold of payment.

You may also find it necessary to re-file an IRS Form W9 to reflect changes in your practice as recommended by your tax accountant. 
ACS subscribes to the IRS TIN Matching Program on the IRS web site .  We use this service to check each IRS form W-9 we receive from our providers.  If the Tax Name and Tax Id Number (TIN) submitted on the IRS Form W-9 does not match the results from the IRS TIN Matching program, that IRS Form W-9 will be rejected.  If your IRS Form W-9 is rejected it can affect the payment cycle for your claims.