My claim was denied stating I need a dental claim form. What should I send with my dental claim?

If submitting claims through the mail or by uploading in your online account, you will need to send a dental claim form that shows the following:

• Your member ID number

• Provider info and unique ID

• Date of service

• Procedure codes that show services performed

• Cost of each code

• Office verification - provider's official stamp on the receipt, or provider’s signature

• Payment assignment to the provider or the plan member

These forms will be completed and given to you at the dental office.