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  • J430d Dental Claim Form 2012 - Florida Blue Dental

Get J430d Dental Claim Form 2012 - Florida Blue Dental

Dental Claim Form Send Completed Claim Form To: Florida Combined Life Dental Claims Department P.O. Box 1047 Elk Grove Village, IL 60009-1047 Dental Claim Form HEADER INFORMATION 1. Type of Transaction.

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Your Dentist should call our claims department at (800) 653-4427, and use our automated benefit system, which will fax your benefit information back to him/her with a quick response. Your dentist should mail claims to: Ameritas Life Insurance Corp. Most dentists will use their own forms and file the claim for you.

The Ameritas Payor ID Number is 47009 and 72630 (NY).

How much time do I have to submit a claim? We recommend that claims be submitted as soon as possible, as dental plans have a timely filing clause. Unless otherwise noted in your certificate, active insured members must submit claims to us within 90 days of the date of service.

6 weeks. Online virtual panel interview and drug test and background.

Use a separate form for each family member and each physician or supplier. Enclose ORIGINAL itemized bills. Keep a copy for your records. • Mail to: Blue Cross and Blue Shield of Florida, PO Box 1798, Jacksonville, FL 32231-0014 see previous page for more instructions.

Prepaid. If you're a BlueDental PPO member, you have access to a large dental network in Florida and nationwide. If you choose a dentist in our network, you can realize greater savings, including low or no out-of-pocket costs for preventive services.

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.

Ameritas Life Insurance Corp. Group Claim Office / P.O. Box 82520 / Lincoln, NE 68501-2520 / Toll Free 800-487-5553 / Fax 402-467-7336 / Web ameritas.com Ameritas' payer ID for electronic claims is 47009.

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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