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Get Denta Quest Transfer Form 2020-2025
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How to fill out the Denta Quest Transfer Form online
Filling out the Denta Quest Transfer Form online is an essential step when transferring patient care from one dental provider to another. This guide will walk you through the process step-by-step to ensure a smooth and accurate submission.
Follow the steps to complete the Denta Quest Transfer Form online.
- Click the ‘Get Form’ button to access the transfer form. This will allow you to open the document and proceed with filling it out.
- Begin by completing the 'Main Dental Provider Information' section. Fill in your full name, provider NPI number, complete address including city, state, and ZIP code, as well as your phone number.
- Next, move to the 'Member Information' section. Here, input the Medicaid or CHIP information, including the member's first and last name, address, date of birth, state, ZIP code, and phone number. Ensure accuracy in the member ID number.
- Proceed to the 'Service Office Name' section, where you will fill in the details of the transfer care dentist. This includes their name, provider NPI number, address, city, state, ZIP code, and phone number.
- In the 'Description / Reason for Interim Care Transfer' section, specify the tooth number and provide a clear description of the request for transferring care.
- Before finalizing, review all entries for accuracy. Once confirmed, you can save changes, download, print, or share the completed form as needed.
Complete the Denta Quest Transfer Form online now to ensure your patient’s continued care.
If you need to void a claim on DentaQuest, first, locate the claim details in your account. Next, you can usually contact DentaQuest customer service for direct assistance, or you may need to fill out a Denta Quest Transfer Form depending on the situation. Ensuring that you follow the correct process helps expedite the resolution and prevents any disruptions in your dental coverage.
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