Get the free Dental Claim Form - Employee Benefit Service
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Dental Claim Forehead INFORmATIONBenefit Administrators, Inc.
1250 Tower Lane Erie, PA 16505
Phone:
(814) 4540167 | (800) 7772524
Fax:
(814) 45922501. Type of Transaction (Mark all applicable boxes)
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What is dental claim form?
A dental claim form is a document submitted by a dentist to an insurance company to request payment for dental services provided to a patient.
Who is required to file dental claim form?
Typically, the dental provider or dental office is required to file the dental claim form on behalf of the patient.
How to fill out dental claim form?
To fill out a dental claim form, you need to provide patient information, details of treatment provided, insurance information, and the dentist's details, including their National Provider Identifier (NPI).
What is the purpose of dental claim form?
The purpose of a dental claim form is to inform the insurance provider about the services rendered, so they can process payments and reimbursements appropriately.
What information must be reported on dental claim form?
The dental claim form must include the patient's personal information, insurance information, treatment dates, procedure codes, and the dentist's signature.
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