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Change of Dental Provider Request Fax to: 4055307178 Please allow 710 business days for request to be processedPrior Authorization # Member Name Member ID # Requested by: Patient/Parent signature
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How to fill out change of dental provider
How to fill out change of dental provider
01
Contact your current dental provider and inform them that you would like to change providers.
02
Research and compare different dental providers in your area to find one that meets your needs.
03
Schedule an appointment with your new dental provider.
04
Obtain any necessary paperwork or forms from your new dental provider.
05
Fill out the change of dental provider form accurately and completely.
06
Submit the form to your new dental provider or insurance company.
07
Follow up with your current dental provider to ensure a smooth transition of your dental records and any outstanding treatments or bills.
08
Communicate any specific requests or concerns to your new dental provider to ensure they are aware of your needs.
Who needs change of dental provider?
01
Anyone who wishes to switch their dental provider.
02
Individuals who have moved to a new location and need a new dental provider.
03
Patients who are dissatisfied with their current dental provider.
04
Employees who change jobs and need to update their dental insurance information.
05
Individuals who want to take advantage of different dental services or discounts offered by a new provider.
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What is change of dental provider?
Change of dental provider is the process of switching from one dental provider to another.
Who is required to file change of dental provider?
Any individual who wishes to switch their dental provider must file the change.
How to fill out change of dental provider?
To fill out the change of dental provider, the individual must contact their current dental provider and request their records to be transferred to the new provider.
What is the purpose of change of dental provider?
The purpose of change of dental provider is to ensure that individuals have access to the dental care that best fits their needs and preferences.
What information must be reported on change of dental provider?
The information that must be reported on the change of dental provider includes the name of the new dental provider, the date of the change, and any relevant medical history.
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