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Insurance Claim Forms

ADA Dental Claim Insurance Claim Forms, 8-1/2" X 11" Letter Size for Laser or Ink Jet Printers (Pack of 100 Sheets)

R 1,335

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ADA Dental Claim Insurance Claim Forms, 8-1/2" X 11" Letter Size for Laser or Ink Jet Printers (Pack of 100 Sheets)
- Comprehensive Form: This ADA American Dental Association Dental Claim Form is a comprehensive document for submitting dental claims and treatment information. Pack of 100 Sheets
- Detailed Sections: The form includes sections for patient information, policyholder/subscriber details, dental benefit plan information, and a record of services provided.
- Coding Support: It allows for entering diagnostic codes, treatment codes, and other relevant coding for proper claim processing.
- Authorization Segment: There is a dedicated section for obtaining authorizations and signatures from the patient or policyholder.
- Dentist Information: The form provides fields to enter the treating dentist's name, address, license number, and other relevant details, Made in the USA by Next Day Labels TM
Country USA
Brand NextDayLabels
Manufacturer NextDayLabels
Binding Office Product
ItemPartNumber NDL-ADA forms
Warranty 1
Size Pack of 100 Sheets
ReleaseDate 0000-00-00