Get R Ar Bcbs Member Application For Dental Claim Reimbursement 2019-2025

Filing a dental claim reimbursement can be a straightforward process if you follow the proper steps. This guide will provide you with clear, detailed instructions on how to fill out the R AR BCBS Member Application for Dental Claim Reimbursement online.

Follow the steps to effectively complete your dental claim application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the enrollee ID, which can be found on your Arkansas Blue Cross and Blue Shield ID card. You will also need to provide the group number associated with your insurance.
3. Complete the enrollee information section by providing the last name, first name, street address, city, state, ZIP code, date of birth, and sex.
4. Indicate whether you have other health insurance coverage by selecting 'Yes' or 'No'. If applicable, provide the name and policy number of the other health insurance.
5. List the provider's name and their NPI/TIN (National Provider Identifier/Tax Identification Number) for the dental service you received.
6. Record the date of service and select the procedure description from the options provided, such as cleaning, oral exam, or x-ray.
7. To ensure quick processing, complete one form for each enrollee and prepare your original itemized bill from your provider that includes necessary details such as date of service, provider name, charge, NPI/TIN, and procedure/code diagnosis.
8. After filling out all required sections, read the certification statement carefully. Sign and date the form to confirm the accuracy of the information provided.
9. Finally, review the completed form for accuracy, then save your changes. You can download, print, or share the filled form as needed before submitting it.

Complete your dental claim reimbursement application online today to ensure timely processing of your claims.