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  • Ada Dental Claim Form 2006 Printable

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ATTENTION DENTAL PROVIDERS 2006 AMERICAN DENTAL ASSOCIATION CLAIM FORM HARDCOPY Effective January 1 2007 Medicaid will begin accepting the new 2006 American Dental Association ADA Claim Form from providers who submit hardcopy claims to Medicaid for prior authorization and payment of dental services.

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Dentists may submit claims for you which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or call 1 800 942-0854.

Sign in to MyBenefits now. Make sure to have the following information available: Your contact information. Disability details. Physician contact information. A MetLife Claims specialist will be in touch within 1-2 business days to confirm next steps.

Supernumerary teeth in the permanent dentition are identified in the ADA's Universal/National. Tooth Designation System ( JP ) by the numbers 51 through 82, beginning with the area of the. upper right third molar, following around the upper arch and continuing on the lower arch to the.

The American Dental Association (ADA) exists to power the profession of dentistry and to assist our members in advancing the overall oral health of their patients.

Mail to: SRC, an Aetna Company. Attn: Claim Department. PO Box 14094. Lexington, KY 40512-4094. Fax to: 1-859-455-8650. Phone: 1-888-772-9682. TO BE COMPLETED BY EMPLOYEE. TO BE COMPLETED BY DENTIST.

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.

Aetna does not provide care or guarantee access to dental services. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and/or group size and are subject to change.

If you do need to file a claim form: Complete the patient and subscriber information on the claim form. Provide a copy of the dentist's Statement of Treatment or a detailed receipt that includes: Name, address and complete phone number of dentist. Date each service was performed.

Timely Filing of Claims Corrected claims must be submitted within 365 days from the date of service. days from primary insurer's EOB date or 180 days from date of service, whichever is later. Failure to submit claims within the prescribed time period may result in payment delay or denial.

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© Copyright 1997-2025
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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