Get Ada 2006 Claim Form

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.

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.

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.

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.

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 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.

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.

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.

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.

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.