Get Hf004

Filling out the Hf004 form online is a straightforward process. This guide provides detailed steps to help you accurately complete each section of the form, ensuring a smooth claims submission experience.

Follow the steps to fill out the Hf004 form accurately.

1. Click ‘Get Form’ button to obtain the form and access it in the editor.
2. Begin filling out the form by entering the policyholder’s dental policy number and their full name as it appears on the Dental Plan ID card.
3. Provide the patient's full name, gender, date of birth, and relationship to the insured.
4. Fill in details about the treatment date, tooth or surface involved, ADA code, and charges for each procedure performed.
5. If the patient is a full-time student aged over 19, please indicate this in the appropriate field.
6. Ensure the dentist’s office completes all necessary fields on the form to prevent any delays caused by missing information.
7. Review the form for accuracy, ensuring all required sections, including the patient's Social Security number, are filled out correctly.
8. Once the form is complete, save your changes, and you can either download or print it for submission.
9. Submit the completed claim form directly to Aflac New York via fax or mail as indicated in the instructions.

Begin your online claims submission process now by completing the Hf004 form.