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HI Dental Service APP 01A 2019-2025 free printable template

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Employer Application For Employers With 1 to 50 Employees Hawaii Dental Service 700 Bishop Street, Suite 700 Honolulu, Hawaii 96813 www.HawaiiDentalService.com Sales@HawaiiDentalService.comPhone:
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How to fill out HI Dental Service APP 01A

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How to fill out HI Dental Service APP 01A

01
Obtain the HI Dental Service APP 01A form from your local dental office or the official website.
02
Fill out your personal information section, including your name, address, and contact details.
03
Provide details about your dental insurance coverage, if applicable.
04
Indicate the purpose of the application, whether it's for initial services or ongoing care.
05
List any relevant medical history or current dental issues that the dentist should be aware of.
06
Review the form thoroughly for accuracy and completeness.
07
Submit the completed form to your dental provider as per their instructions.

Who needs HI Dental Service APP 01A?

01
Individuals seeking dental services covered under the HI program.
02
Patients without insurance who require assistance with dental care costs.
03
Families looking to enroll multiple members in the HI Dental Services program.
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HI Dental Service APP 01A is an application form used for dental service requests and claims within the HI (Health Insurance) system.
Providers of dental services who wish to request reimbursement for services rendered to patients under the HI insurance program are required to file HI Dental Service APP 01A.
To fill out HI Dental Service APP 01A, complete all required sections, including patient information, details of services rendered, provider information, and any supporting documentation as specified in the guidelines.
The purpose of HI Dental Service APP 01A is to facilitate the reimbursement process for dental services provided to patients covered by the HI insurance program.
The information that must be reported on HI Dental Service APP 01A includes patient details, date of service, description of services performed, provider details, and any relevant insurance or billing information.
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