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How to fill out the Connectanthemdentaladmincom Form online
Filling out the Connectanthemdentaladmincom Form is an important step for individuals accessing online enrollment services. This guide provides a step-by-step approach to help users complete the form accurately and efficiently.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to obtain the form and open it in your editor.
- Complete the company information section. You will need to provide the date, main company contact name, company name or group number, main company contact email, and main company contact telephone number.
- Fill out the user information section for the person utilizing the secured website section. Include the user name, job title, and select the options being requested, such as 'Online Enrollment Inquiry Only' or 'Online Enrollment Add/Change'. For each requested option, list the group and subgroup number(s) as required.
- Provide the user telephone number and the user email address.
- Have the group administrator sign the authorization section to grant access to online enrollment records. Indicate the date of the signature.
- An Anthem Dental Marketing Representative or Account Manager will complete the security information section. Ensure the form indicates whether it is incomplete, the plan number, and the marketing approval initials and date.
- The enrollment department will fill in the user password information, including the applications section that specifies the type of request.
- After all sections are completed, save the document using your company name. For small groups, email the form to connect@anthemdentaladmin.com or fax to 1-877-604-2124. For large groups, email the form to lgimplementation@anthemdentaladmin.com or fax to 1-877-201-8379.
Submit your completed Connectanthemdentaladmincom Form online today.
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