Get Dental Claim Forms Axa

Filling out the Dental Claim Forms Axa is a crucial step in securing your dental insurance benefits. This guide provides a comprehensive overview of the form and offers clear, step-by-step instructions to help you complete it efficiently online.

Follow the steps to successfully complete the dental claim form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin filling out section A, Administrative, which requires your policy or membership number, patient details including name, date of birth, gender, contact information, and the plan type.
3. Proceed to section B, To be completed by dentist. Here, the dentist should provide information regarding the duration of illness, date of consult, chief complaint, diagnosis, and any relevant procedures performed.
4. In section C, Treatment advised/further treatment planned, ensure that the dentist records details about any prescribed medications or any follow-up treatments that are recommended.
5. Complete section D, Other insurer’s details by answering whether the treatment was accident-related or covered under another insurance policy. If applicable, provide details of the other insurance company.
6. Move to section E, Administrative specific to reimbursement claims. Here, indicate the amount claimed, ensuring it is supported by original invoices and prescription details, include beneficiary information, bank details for telegraphic transfer, and the currency of treatment.
7. Finally, review the Patient's Declaration and Medical Practitioner Declaration sections. Ensure signatures and dates are filled in, and verify that all information is accurate before submission.
8. Save your changes to the form, ensuring all required fields have been completed. You can then download, print, or share the completed form as needed.

Get started with your claims process by filling out the Dental Claim Forms Axa online today!