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  • Carefirst Dental Claim Form

Get Carefirst Dental Claim Form

MEMBER DENTAL CLAIM FORM Please type or print 1. Identification Number 4. Patient's Date of Birth Month Day Year 2. Group Number 5. Patient's Sex Female c Male c 3. Patient's name (First, Middle Initial,.

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Contact support

For additional information, contact us Monday-Thursday 8 a.m. to 5 p.m. or Friday 10 a.m. to 5 p.m. at 855-503-4862, or visit our dental page for a quick and easy quote.

For more information, call Member Services at 855-290-5744 (TTY: 711).

How can you submit a grievance? Call: 855-290-5744. You can also fax or mail your grievance in writing to us at: Fax: 443-753-2298. Mail: CareFirst BlueCross BlueShield Medicare Advantage. P.O. Box 3626. Scranton, PA 18505. Online: Complete the Medicare Complaint Form.

The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan. ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers.

Monday - Friday, 7:00 a.m.-6:00 p.m. (Eastern Time). Or, visit Contact Us to find a department/resource list to assist you.

Answer: If you do not currently use a vendor, contact one of our preferred clearinghouses. What is CareFirst's payer ID code? Answer: Please use payer ID code 00580 to submit dental claims electronically. What provider number should I use when submitting electronically?

We're on a mission to make quality care affordable, easy to use and available to everyone in Maryland, Washington, D.C. and Northern Virginia.

CareFirst Administrators (CFA) is a third-party health benefits administrator in Maryland, Washington D.C. and Northern Virginia. Locally, we are backed by CareFirst BlueCross BlueShield (CareFirst), and we are nationally supported by the Blue Cross and Blue Shield Association (BCBSA).

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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