Get Bnationalb Dental Hygiene Bclaim Formb - Files Cdha

Completing the National Dental Hygiene Claim Form online is a straightforward process designed to assist users in submitting their claims for dental hygiene services. This guide will provide you with step-by-step instructions for filling out each section of the form with clarity and precision.

Follow the steps to successfully complete your claim form.

1. Click the ‘Get Form’ button to obtain the form and access it in your preferred editor.
2. Begin with Part 1, which captures information about the registered dental hygienist. Enter the office number and CDHA UIN, along with the hygienist's last name and first name. Fill in the address, including the apartment number (if applicable), city, province, and postal code. Provide the hygienist’s telephone number and the date of service.
3. In Part 1, indicate the CDHA service code applicable to the services rendered. If your plan allows, authorize the assignment of benefits by signing where indicated.
4. Proceed to input details about the service provided, including the tooth code, the dental hygienist’s fee, and any laboratory charges or expenses. Ensure the total cost is calculated accurately.
5. Lock in your total amount submitted and verify any additional information required by the registered dental hygienist. Check if preauthorization is needed.
6. Move to Part 2 to complete details about the employee, plan member, or subscriber. Fill out group policy/plan number, the insurer/administrator, and the employer details. Include your date of birth and personal details as prompted.
7. In Part 3, provide client or patient information. If the client is different from the person submitting the claim, fill out their relationship, date of birth, and any relevant details regarding disability or student status.
8. Answer questions about any other dental hygiene benefits or services you may have, and confirm if the treatment was a result of an accident.
9. Lastly, review the entire form for accuracy and completeness. Ensure that all required signatures are present. Once you are done, save your changes, and you can choose to download, print, or share the completed form as needed.

Complete your forms online with ease and ensure your dental hygiene claims are submitted correctly today.