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Sun Life Assurance Company of CanadaMEMBER DENTAL CLAIM FORM Please submit claim to:HEADER INFORMATIONDental Claims P.O. Box 69421 Harrisburg, PA 1710694211. Type of Transaction (Mark all applicable
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How to fill out gdfm-1370standarddentalclaimfinal16doc
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To fill out the gdfm-1370standarddentalclaimfinal16doc form, follow these steps:
02
Start by entering the patient's personal information, including their name, date of birth, and contact details.
03
Next, provide the patient's insurance information, such as the name of the insurance company, policy number, and group number.
04
Indicate the dentist's name and contact details in the designated section.
05
Specify the dental office's information, including the name, address, and phone number.
06
Enter the date of service and the patient's diagnosis code.
07
Provide a detailed description of the dental procedures performed, including the procedure codes and fees for each.
08
If any additional procedures or services were provided, make sure to include them as well.
09
Indicate any applicable tooth numbers or surfaces for each procedure.
10
Calculate the total fee for the dental services rendered.
11
Finally, the dentist or authorized personnel must sign and date the form.
12
Remember to double-check all the information entered before submitting the completed form.
Who needs gdfm-1370standarddentalclaimfinal16doc?
01
The gdfm-1370standarddentalclaimfinal16doc form is needed by dental professionals who need to submit dental insurance claims on behalf of their patients.
02
It is typically used by dentists, dental hygienists, and dental office administrators.
03
This form allows dental providers to itemize the procedures performed, their associated fees, and submit them to the patient's insurance company for reimbursement.
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What is gdfm-1370standarddentalclaimfinal16doc?
gdfm-1370standarddentalclaimfinal16doc is a standard dental claim form used for submitting dental claims to insurance companies.
Who is required to file gdfm-1370standarddentalclaimfinal16doc?
Dentists and dental offices are required to file gdfm-1370standarddentalclaimfinal16doc when submitting claims for dental services provided to patients.
How to fill out gdfm-1370standarddentalclaimfinal16doc?
To fill out gdfm-1370standarddentalclaimfinal16doc, you will need to provide information such as patient demographics, treatment details, and insurance information.
What is the purpose of gdfm-1370standarddentalclaimfinal16doc?
The purpose of gdfm-1370standarddentalclaimfinal16doc is to facilitate the processing of dental insurance claims and ensure proper reimbursement for dental services.
What information must be reported on gdfm-1370standarddentalclaimfinal16doc?
Information such as patient name, date of birth, treatment dates, procedure codes, and provider details must be reported on gdfm-1370standarddentalclaimfinal16doc.
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