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THIS DENTAL PLAN IS NOT AN ESSENTIAL HEALTH BENEFIT PEDIATRIC ORAL CARE PLAN. Cagney Health and Life Insurance Company may change the premiums of this Policy after 30 days written notice to the Insured
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How to fill out sd-cigna-dental-1500-policy-clean

01
Start by entering the date of service in the provided space.
02
Fill in the patient's information, including their name, address, and contact details.
03
Provide the policyholder's information, if different from the patient's.
04
Indicate the relationship of the policyholder to the patient, if applicable.
05
Enter the subscriber's ID number and group number, which can be found on the insurance card.
06
Specify the provider's information, including their name, address, and contact details.
07
Describe the dental procedure or treatment performed, including the date and fee.
08
Include any relevant dental codes or procedure numbers.
09
Note down if the treatment was due to an accident or injury.
10
Finally, sign and date the form, certifying its accuracy and completeness.

Who needs sd-cigna-dental-1500-policy-clean?

01
Anyone who has a Cigna dental insurance policy and is seeking to file a claim for dental services can use the sd-cigna-dental-1500-policy-clean form.
02
This form is typically used by individuals who have received dental treatment or procedures covered by their Cigna dental insurance plan and need to submit a claim to the insurance company for reimbursement.
03
It is also used by dental providers who need to document and submit the details of the services rendered to Cigna for payment.
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The sd-cigna-dental-1500-policy-clean is a dental insurance policy form used by providers to submit claims for dental services covered under Cigna's dental plans, specifically designed to meet certain clean claim requirements.
Dental healthcare providers, including dentists and dental clinics, who offer services covered under the Cigna dental plans are required to file the sd-cigna-dental-1500-policy-clean for reimbursement.
To fill out the sd-cigna-dental-1500-policy-clean, providers need to complete the necessary fields including patient information, provider details, service codes, and other relevant information as specified by Cigna's guidelines.
The purpose of the sd-cigna-dental-1500-policy-clean is to standardize the process of submitting dental claims electronically and to ensure that claims are clear, complete, and compliant with Cigna's requirements for faster processing and payment.
Information that must be reported includes patient name, identification number, provider name, treatment dates, service codes, any relevant diagnosis codes, and total charges.
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