Get Claim Form And Instructions For Members - Decare

This guide provides clear and supportive instructions on completing the Claim Form And Instructions For Members - DeCare online. By following the steps outlined here, users can ensure accurate and timely processing of their dental claims.

Follow the steps to complete the claim form accurately.

1. Click ‘Get Form’ button to access the claim form and open it in your chosen editing software.
2. Read through the entire form and familiarize yourself with the sections. The form includes general information, employee and patient information, dentist information, a description of services, and emergency services.
3. In Section A, provide general information as required. Indicate if you are a member residing in the United States receiving emergency care abroad or if you are enrolled in the Expatriate Dental Program living outside the United States.
4. In Section B, fill out employee and patient information accurately. Include the patient's name, identification numbers, dates of birth, and contact information. Be sure to indicate if the patient is a full-time student.
5. Section C requires you to fill in the dentist's information. Input the dentist's name, title, and contact details. If the dentist is unable to complete this section, attach their billing statement.
6. In Section D, describe the services provided. List the service rendered, corresponding codes, date of service, tooth number, surfaces, and fees in the appropriate fields. Ensure all information is correct and clearly legible.
7. Section E asks if the dental services were for emergencies while traveling outside the United States. If applicable, attach the necessary invoice from the dentist.
8. Sign the claim form in the patient’s signature space. If submitting electronically, typing the name suffices as a signature.
9. A dentist's signature is also required. Ensure you have permission if submitting electronically.
10. Once all information is completed, review the form for any errors or missing information. Save your changes.
11. Finally, you can download, print, or share the completed claim form as needed.

Complete your claim forms diligently online for prompt processing.