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Dental Claim Form
HEADER INFORMATION White Plains Teachers Association
c/o Zenith American Solutions
PO BOX 5817
Wallingford, CT 0649276171. Type of Transaction (Mark all applicable boxes)
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How to fill out white plains dental claim
How to fill out white plains dental claim
01
Obtain the White Plains Dental Claim form from your dental insurance provider or download it from their website.
02
Fill in your personal information, including your name, address, phone number, and insurance policy number.
03
Provide the details of the dental service you received, including the date of service, the dentist's name, and the procedure codes.
04
Attach any supporting documents, such as receipts or invoices, detailing the cost of the dental service.
05
Sign and date the claim form to certify the accuracy of the information provided.
06
Submit the completed claim form and supporting documents to your dental insurance provider via mail or online submission portal.
07
Keep a copy of the completed claim form and supporting documents for your records.
Who needs white plains dental claim?
01
Anyone who has received dental services covered by their dental insurance policy and wants to seek reimbursement for the expenses incurred needs to fill out a White Plains Dental Claim form.
02
This form is typically required by dental insurance providers to process claims and provide reimbursement to policyholders.
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What is white plains dental claim?
White Plains Dental Claim is a form that dentists use to request payment for services provided to patients with dental insurance.
Who is required to file white plains dental claim?
Dentists who provide services to patients with dental insurance are required to file White Plains Dental Claims.
How to fill out white plains dental claim?
White Plains Dental Claim forms can be filled out manually or electronically, providing information about the services provided, patient details, insurance information, and charges incurred.
What is the purpose of white plains dental claim?
The purpose of White Plains Dental Claim is to request reimbursement from dental insurance companies for services provided to patients.
What information must be reported on white plains dental claim?
Information such as patient details, treatment provided, fees charged, insurance information, and dentist's details must be reported on White Plains Dental Claim.
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