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  • Dentaquest Non Covered Services Form

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Agreement to Pay NonCovered Services Patient Name: Member(Medicaid) ID: Guarantor Name: Relationship to Patient: Not all dental services are covered by the TennCaer Dental Program. Some services are.

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DentaQuest.com or by calling Member Services at 1-888-468-5509, TTY: 1-800-466-7566.

PPO plans are available in the following states: AZ, GA, IL, MO, OH, TX & VA with out-of-network coverage....DentaQuest will pay. Diagnostic and preventive servicesNone100%Complex dental services$100 per covered individual / $300 per family30%Orthodontics (under age 19)Not a covered serviceNot a covered benefit1 more row

Related Definitions Not Reviewed means submittals were not required and have not been reviewed or were provided for information only..

Guardians or Case workers needing assistance with registration or receiving registration errors please contact Customer Service at 800-895-2218.

If you have questions about your current coverage, please call 800-523-2863.

Fax paper claims to: 1-262-834-3589 Electronic claims: provideraccess.dentaquest.com Payor ID is BBMDQ.

What is MetLife's Payor ID for electronic claims submission? MetLife's Payor ID for electronic claims is 65978. Where do I submit claims and requests for pretreatment estimates?

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232