Dental Paper Claim Submission

Policy Number: DP-X-009

Last Updated: Sept. 15, 2022

Paper claims are entered into our claim processing system by transforming claim information to an electronic format. If the claim cannot be entered electronically, it is delayed for research and entered manually by an auditor. Electronically entered claims go into our processing system more quickly and more accurately than paper claims that must be manually entered.  

To expedite claims payment, always obtain form copies from the ADA by calling 800-947-4746 or visiting  

  • Claims must be submitted on 2012 or newer forms;  
  • Claims submitted on forms older than 2012 will be returned. 

The member ID MUST be populated on Form Locator 15 on the 2016 Dental Claim Form and newer forms.  

(When the member ID is not added to that section, it could delay processing of the claim.) 

Please mail your paper claims to:  

Blue Cross and Blue Shield of Nebraska  
P.O. Box 3248  
Omaha, NE 68180-0001