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Comprehensive ADA Dental Claim Form completion instructions are printed in the CDT manual. ... PDF — DENTAL CLAIM FORM — FEP Blue. CUT0131-1S Rev.
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01
Gather all the necessary information and documents needed to fill out the form.
02
Read the instructions carefully to understand the required fields and any specific guidelines.
03
Start filling out the form by entering your personal details such as name, address, and contact information.
04
Follow the format specified for providing dates, such as using the DD/MM/YYYY format.
05
Provide accurate and complete information in each section of the form.
06
If there are multiple sections, fill them out in the order specified.
07
If certain sections are not applicable to you, mark them as N/A or leave them blank as instructed.
08
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09
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10
If any supporting documents are required, make sure to attach them to the form.
11
Carefully review the instructions again to ensure you haven't missed anything.
12
Once you are satisfied with the form, place it in an envelope to be mailed. Do not fax or email the form.
13
Ensure the mailing address provided in the instructions is correct and legible.
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Consider sending the form through certified mail or with tracking to ensure its safe delivery.
15
Keep a copy of the filled-out form and any supporting documents for your records.
Who needs instructionsformsmustbemailednofaxesoremails?
01
Individuals who are required to submit specific forms that explicitly mention 'must be mailed, no faxes or emails' as the submission method.
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The instructions form must be mailed, no faxes or emails are accepted.
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