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DOMINION DENTAL SERVICES, INC. AND DOMINION DENTAL SERVICES USA, INC. VIRGINIA ORTHODONTIC PROVIDER AGREEMENT This Agreement is made and entered into this day of, (year), by and between (hereinafter
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How to fill out virginia orthodontic provider agreement

01
To fill out the Virginia orthodontic provider agreement, follow these steps:
02
Start by reading the agreement thoroughly to understand the terms and conditions.
03
Begin by entering your personal information in the designated fields, such as your name, contact details, and any relevant licensure or credentials.
04
Provide your business information, including the name of your orthodontic practice, address, and contact details.
05
Review the payment and reimbursement terms and ensure they align with your expectations.
06
Carefully read through the sections related to services provided, patient communication, and record-keeping obligations, making any necessary adjustments or additions.
07
If required, specify any additional provisions or agreements you may have with other parties, such as laboratories or referral sources.
08
Pay attention to any insurance requirements or liability provisions outlined in the agreement.
09
Once you have filled in all the necessary fields and made any desired changes, review the agreement one final time to ensure accuracy and completeness.
10
Sign and date the agreement in the designated areas.
11
Keep a copy of the fully executed agreement for your records.
12
Note: It is recommended to consult with a legal professional before signing any provider agreement to ensure understanding and compliance with applicable laws and regulations.

Who needs virginia orthodontic provider agreement?

01
Virginia orthodontic provider agreement is required by orthodontic practitioners in Virginia who are entering into an agreement or contract with insurance companies or third-party payers. This agreement outlines the terms and conditions of providing orthodontic services and serves to protect the rights and interests of both the provider and the payer. It is necessary for orthodontic practitioners who wish to participate in insurance networks or receive reimbursement for services rendered.
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Virginia orthodontic provider agreement is a contract between an orthodontic provider and a dental insurance company operating in the state of Virginia.
Orthodontic providers who wish to offer their services to patients covered by dental insurance in Virginia are required to file the provider agreement.
The provider agreement can be filled out online or through paper forms provided by the dental insurance company. It typically requires information about the provider's services, fees, and terms of payment.
The purpose of the provider agreement is to establish a contractual relationship between the orthodontic provider and the dental insurance company, outlining the terms under which the provider's services will be covered.
The provider agreement typically requires information such as the provider's name, contact information, services offered, fees, and terms of payment.
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