Get Regarding Electronic Claim Submissions.

Filling out the REGARDING ELECTRONIC CLAIM SUBMISSIONS form is a crucial step in ensuring that your dental claims are processed efficiently. This guide provides clear, step-by-step instructions to help you complete the form accurately, making the submission process smooth and straightforward.

Follow the steps to complete the electronic claim submission form effectively.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by filling out the required blocks for the employee, including their name, birthdate, and address in blocks 1 through 7. Ensure all information is accurate and up-to-date.
3. In block 8, provide the employee's daytime telephone number for contact purposes.
4. Continue to fill in patient information in blocks 9 through 15, including the patient's name, birthdate, relationship to the employee, and other relevant details such as employment status if applicable.
5. Indicate whether the claim is related to employment or an accident in blocks 20 and 21. This information is essential for claims processing.
6. If there are any other dental coverage plans in place, complete blocks 23 through 24, providing details of the additional policy or plan as required.
7. In block 28, sign the authorization to release information, ensuring you understand that your signature allows necessary information sharing with relevant entities.
8. If you wish for benefits to be paid directly to your dentist, sign block 29. This step is crucial for ensuring timely payment to your healthcare provider.
9. For the dentist section, blocks 30 through 48 need to be filled accurately. The dentist should check the Statement of Services Rendered box and provide details for all services performed.
10. Once all fields are complete, review the entire form to ensure all information is accurate and complete before submission.
11. Save your changes, and prepare to download, print, or share the completed form as needed to submit to Aetna Dental at the address provided.

Complete your electronic claim submissions online today for a hassle-free claims process!