Coverage notes per insurance carrier — update continuously
Structure: Each carrier has a section with: specific rule, affected code, verification date, call reference number. Always document the ref number when applicable.
Aetna
Code
Rule
Ref / Date
837D
Does NOT accept 837D via Stedi — use alternative channel
Cache 2026-05-08
276/277
Accepts claim status
Cache 2026-05-08
270/271
Accepts eligibility
Cache 2026-05-08
Ameritas
Code
Rule
Ref / Date
D4341/D4342
SRPs: 4 quads per visit, all plans
Ref #2784
D2740 (Crown)
Paid on prep day, all plans
Ref #22087
Cigna
Code
Rule
Ref / Date
D7953
Bone graft only same day as extraction for ridge preservation for future implant
Ref #2000449671055
276
Sometimes returns "Cannot provide further status electronically" — case by case
Cache 2026-05-08
837D
Accepts via Stedi
Delta Dental
Variant
Rule
Notes
Delta Dental Illinois (05030)
Not configured for 276 Claim Status
Verify manually
Delta Dental Missouri (43090)
Not configured for 276
Verify manually
Delta Dental Washington (91062)
Not configured for 276
Verify manually
Delta Dental Georgia (94276)
Not configured for 276 — use portal
Delta Dental Michigan (DDPM)
Not configured for 276
Delta Dental Tennessee (CDTN1 / VDXNK)
Not configured for 276 Claim Status
Cache 2026-05-12
Guardian
Code
Rule
Notes
276
Not configured for Claim Status Inquiry
Cache 2026-05-08
Humana
Code
Rule
Notes
276
Supports claim status
Humana / Careington (DPP)
Code
Rule
Notes
270/276
DPP — Stedi doesn't work. Discount plan, not traditional payer
Cache 2026-05-08
MetLife
Code
Rule
Notes
276
Requires KNDAF mapping, but even that doesn't support 276 via Stedi
Cache 2026-05-08
United Healthcare
Code
Rule
Notes
276
"Cannot provide further status electronically" — use manual portal
Cache 2026-05-08
270
Accepts eligibility
Florida Health Solution
Item
Detail
In-network provider
Dr. (Le Dentiste)
How they pay
Paid via the Fee Schedule they provide (sent by fax). Some codes the patient pays $0 and insurance pays directly (e.g. consultation).
How to inform them
By phone at (305) 269-2000. Inform them of appointment day and time → they authorize and provide an authorization number.
Recommendation
Have the ADA codes ready during the call so they confirm whether patient or insurance pays
How they pay
By check, indicating the authorization number
Specific workflow:
For each FL Health Solution patient: call before the appointment to (305) 269-2000, give day/time + ADA codes, write the authorization number in the patient chart. When collecting (check), match the authorization number against the one in the chart.
Example case:
Recent patient — authorization number 2148229128 — codes performed that day can be added to that authorization.
Florida Combined Life / BCBSF
Code
Rule
Notes
270/276
Works but sometimes E0 if subscriber data invalid
Cache 2026-05-08
Aetna Medicare Assure
Code
Rule
Notes
276
Payer CX083 (Stedi: XYAGN) not configured for 276
Cache 2026-05-12
Universal rules (carrier-independent)
D4921 (gingival irrigation): 99% not covered — do NOT submit
D0470 (diagnostic casts): If not covered → write off
D9910 (desensitizing): Some cover, many deny
Cosmetics (D2960-2962, whitening): do NOT submit
Maintenance: This list grows. Whenever you discover a new carrier rule, add it here with date + ref number. Automated source is payer_capabilities.json in the Claims repo.
