Member Guide to Dental Networks, Eligibility & Claims
ID Card Example
1
Nippon Life Benefits is the Insurance Carrier
2
Aetna is the Dental Provider Network*
If a provider says they don’t accept Nippon Life Benefits, but you see them listed in the directory
1. Tell the provider: “My insurance is Nippon Life Benefits, and my plan uses the Aetna Dental PPO network.”
2. Confirm network participation- ask “Do you participate with Aetna Dental PPO?”
3. If yes: Tell the provider that they are in-network for Nippon Life Benefits because your plan uses the Aetna Dental PPO network.
4. If they say no: Explain that they are listed in Aetna’s dental provider directory.
5. If still unresolved: Contact Nippon Life Benefits Customer Service at 800-374-1835.
If a provider says they can’t find or verify your eligibility
1. Tell the provider that Nippon Life Benefits not Aetna handles eligibility and benefits.
2. Ask if they use an online eligibility verification service.
3. If yes, tell the provider that they must use Payer ID “NIPON” or “81264” to find you. Your eligibility will not be found under Aetna or a general search.
4. If no, tell the provider to verify by calling Nippon Life Benefits at 800-374-1835.
If a provider asks about billing or reimbursement
1. Tell the provider that Nippon Life Benefits reimburses based on their Aetna dental PPO contract.
2. If the provider is in-network, you should not pay upfront.
3. Tell the provider to bill Nippon Life Benefits not Aetna.
4. Electronic claims should be sent to Payer ID 81264.
5. Paper claims should be mailed to Nippon Life Benefits, PO Box 4387, Clinton, IA, 52733.
6. For claims questions, providers should contact Nippon Life Benefits, not Aetna.
When visiting a provider, please present your ID card at reception. For a smoother experience, kindly note that (1) Nippon Life Benefits is your insurance carrier, and (2) Aetna is your dental provider network. *Nippon Life Benefits members access the Aetna Dental PPO network via Aetna Dental Administrators (ADA) nationally.
Have questions or need help?: Call Nippon Life Benefits Customer Service at 800-374-1835