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Affinity Markets Dental Claim PART 1 DENTIST LAST Communiqué NO.GIVEN NAME A T ADDRESS I E N CITY TAPE.PROV.POSTAL CODES PEC.PATIENT IS OFFICE ACCT. NO. D E N T I S PHONE NO. T I HEREBY ASSIGN MY
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How to fill out affinity markets dental claim
How to fill out affinity markets dental claim
01
To fill out Affinity Markets Dental Claim, follow these steps:
1. Obtain the claim form from Affinity Markets or download it from their website.
02
Fill in your personal information, including your name, address, and contact information.
03
Provide your policy information, such as your policy number and group number.
04
Indicate the date of service and the name of the dental provider.
05
Itemize the dental services received, including the procedure codes and the fees charged.
06
Attach any necessary supporting documents, such as dental X-rays or invoices.
07
Sign and date the claim form.
08
Submit the completed claim form and supporting documents through the designated submission method, such as mail or online.
Who needs affinity markets dental claim?
01
Affinity Markets Dental Claim is needed by individuals who have dental insurance coverage through Affinity Markets.
02
These individuals may have received dental services and are seeking reimbursement for the expenses incurred.
03
People who want to file a claim for dental services covered by their Affinity Markets dental insurance policy also need to fill out an Affinity Markets Dental Claim.
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