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Get Aflac Hf004 2005
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How to fill out the AFLAC HF004 online
The AFLAC HF004 form is essential for submitting dental claims, ensuring that you receive the benefits due to you under your policy. This guide will walk you through each step, highlighting the information needed to complete the form accurately.
Follow the steps to effectively complete the AFLAC HF004 form.
- Click the ‘Get Form’ button to obtain the AFLAC HF004 form and open it in your preferred editor.
- Begin by filling in the policyholder's dental policy number, ensuring that the Group Field is left blank as instructed.
- Provide the policyholder's complete name as it appears on the Dental Plan ID card for accurate identification.
- Enter the patient's full name, sex, date of birth, and their relationship to the policyholder.
- Detail the treatment date, the tooth or surface involved, the oral cavity where treatment was performed, ADA code, and the associated charges for each procedure.
- Include the patient's Social Security number to help expedite the claim processing.
- If the patient is a full-time student over the age of 19, make sure to indicate this on the form.
- If applicable, specify that you are filing for benefits under the orthodontic rider or a cosmetic rider, noting the two-year waiting period for these benefits.
- Ensure that your dentist submits the claim electronically, including Aflac's payer number (58066) on each claim.
- Once all sections are completed accurately, save your changes, then download or print the form to submit it to Aflac’s Claims Department at the listed address or via fax.
Complete your dental claim form online today to ensure a smooth submission process.
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Yes, there is a time limit to file an Aflac claim with AFLAC HF004. Claims for eligible services should be submitted within 12 months of the service date. This guideline helps maintain an efficient claims process and ensures that your claims are processed timely. If you are unsure about your specific situation, consider using the US Legal Forms platform for detailed guidance.
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