Get the free ORTHODONTIA REQUEST FORM
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DO NOT WRITE IN THIS SPACEORTHODONTIA REQUEST FORM Mail: PO Box 65339, Vancouver, BCV5N 5P3 |Telephone: 604 4192000 |Toll-free: 1 877 PABLUM | PAC.blue cross.ca ll requests for orthodontia coverage/eligibility
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How to fill out orthodontia request form
How to fill out orthodontia request form
01
Gather all necessary information such as personal details, insurance information, and reason for orthodontic treatment.
02
Fill out the patient information section including name, date of birth, contact information, and specific dental concerns.
03
Provide insurance details including policy number, group number, and any required pre-authorization information.
04
Clearly state the reason for the orthodontic treatment and desired outcome.
05
Ask your dentist or orthodontist to review and sign the form before submitting it to the insurance provider.
Who needs orthodontia request form?
01
Individuals who are seeking orthodontic treatment such as braces or Invisalign.
02
Parents or guardians of minors who require orthodontic care.
03
Dentists or orthodontists requesting pre-authorization from insurance providers for orthodontic treatment.
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What is orthodontia request form?
Orthodontia request form is a document used to request orthodontic treatment for a patient.
Who is required to file orthodontia request form?
The orthodontist or dentist providing the treatment is required to file the orthodontia request form.
How to fill out orthodontia request form?
To fill out the orthodontia request form, the provider must include patient information, treatment plan, and justification for the treatment.
What is the purpose of orthodontia request form?
The purpose of the orthodontia request form is to request approval for orthodontic treatment from the insurance provider.
What information must be reported on orthodontia request form?
The orthodontia request form must include patient demographics, treatment plan, X-rays, and diagnosis.
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