Get the free GROUP DENTAL CLAIM FORM - EBS-RMSCO, Inc

Mail Form to: EBS-RMSCO, Inc. P.O. Box 4863 Syracuse, NY 13221-4863 For information please call: 1-800-803-5773 Toll Free (315) 671-9894 Pre-Treatment Estimate Statement of Actual GROUP DENTAL CLAIM

How to fill out group dental claim form

How to fill out a group dental claim form:

1. Start by gathering the necessary information. This includes the policyholder's personal details, such as their name, address, and phone number. You will also need the policyholder's group number and insurance information.
2. Next, identify the dental procedure for which you are submitting a claim. Specify the date of the procedure and provide a brief description of the treatment received.
3. Fill in the dentist's information, including their name, address, and contact details. Make sure to include their tax identification number as well.
4. Indicate whether or not the procedure was related to an accident or injury. If it was, provide details about the accident, such as the date and cause.
5. Include any additional information or documentation required by your insurance provider. This may include attaching itemized bills, X-rays, or other supporting documents. Be sure to double-check the specific requirements of your insurance policy.
6. Review the completed form for accuracy and make any necessary corrections. It's crucial to ensure that all the information provided is correct to avoid delays or issues with your claim.

Who needs a group dental claim form:

1. Employees who are covered under a group dental insurance plan provided by their employer typically need to fill out a group dental claim form. This is required when they have received dental treatment covered by their insurance policy.
2. Policyholders under a group dental insurance plan who have dependents also need to fill out a group dental claim form on behalf of their dependents. This may include family members such as a spouse or children.
3. Dental service providers, such as dentists or dental clinics, may also need to fill out a section of the group dental claim form to provide their information and details about the treatment provided.

For pdfFiller’s FAQs

What is group dental claim form?

A group dental claim form is a document used to submit claims for dental services provided to a group of individuals covered under a dental insurance plan.

Who is required to file group dental claim form?

The policyholder or the group administrator is typically required to file the group dental claim form on behalf of the insured individuals covered under the dental insurance plan.

How to fill out group dental claim form?

To fill out a group dental claim form, provide all requested information about the dental services received, including the date of service, type of treatment, and the dentist's information. Make sure to include all necessary supporting documents, such as receipts or invoices.

What is the purpose of group dental claim form?

The purpose of the group dental claim form is to request reimbursement for dental services provided to individuals covered under a dental insurance plan.

What information must be reported on group dental claim form?

The group dental claim form typically requires information such as the patient's name, insurance policy number, date of service, type of treatment received, and the dentist's information.

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