Get Dc 37 Dental Form

The Dc 37 Dental Form is essential for submitting requests for dental services under the DC 37 Health and Security Plan. This guide provides step-by-step instructions to assist users in completing the form correctly and efficiently online.

Follow the steps to successfully complete the Dc 37 Dental Form.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated editing interface.
2. Fill out the Policy Holder/Subscriber section by providing all required information in boxes #4 to #23. Ensure that all details are accurate and complete to prevent any delays.
3. In box #36, the member, patient, or guardian of a minor must include the date and provide a signature or indicate ‘signature on file’.
4. Complete box #37 to authorize payment to the dentist, ensuring that the authorization aligns with the services requested.
5. The dentist must fill out their section with all necessary details, including the social security number or tax identification number and the full address.
6. In the treatment area, itemize all procedures and fees separately. Include specific information such as tooth numbers, quadrant codes, dollar amounts for each procedure, and the total dollar amount in box #32. Remember that only CDT codes will be accepted in column #29.
7. Attach all necessary mounted x-rays to the request for pre-authorization or claims for completed services to support the request.
8. To expedite processing, submit the claims or requests for pre-authorization electronically rather than on paper. Ensure all documentation includes the member’s name, social security number, or PID number.
9. Finally, review the form for completeness and accuracy. Save any changes, download the document, or print and share it as needed. Remember to file claims for completed services within 30 days.

Start filling out your Dc 37 Dental Form online today to ensure your claims are processed smoothly.