Get Groupsource Standard Dental Suite 400 1550 - 5th Street S - Groupsource

Navigating the GroupSource STANDARD DENTAL claim form can be straightforward if you follow detailed instructions. This guide provides a step-by-step approach to ensure that you accurately complete the form and facilitate the claims process effectively.

Follow the steps to successfully complete the GroupSource STANDARD DENTAL claim form.

1. Press the ‘Get Form’ button to obtain the form and launch it in the editor.
2. Complete Part 1, which includes dentist information. Fill out the dentist's last name, given name, address, city, province, postal code, phone number, and their office account number. Provide any necessary information such as pre-treatment x-rays required for estimates.
3. In Part 2, enter patient information. Indicate the relationship of the patient to the employee, the date of birth, and if applicable, details regarding dependent status, educational status for full-time students, and any relevance to workers’ compensation benefits.
4. Complete Part 3 with employee information. Enter your policy number, employer name, employee last name, first name, identification number, gender, date of birth, and contact details including telephone numbers.
5. In Part 4, provide the authorization and declaration. Confirm that all submission information is complete and accurate, and include the required original signature for validation. Ensure to also include the date of signing.
6. Finally, review all sections for completeness. Save your changes, and if necessary, download, print, or share the form to submit to your dentist or insurance provider.

Start completing your GroupSource STANDARD DENTAL claim form online today.