Please use the following checklist of necessary information to ensure the fastest processing of your claims:

• Social Security number of the Employee

• Employee's signature on the claim form

• Patient's name

• Answer all questions on the claim form (including the other insurance information, even if you don't have other insurance)

• Be sure to answer the questions regarding whether the member or dependent has Medicare coverage.

Please use the following checklist of necessary information to ensure the fastest processing of your claims:

• Social Security number of the Employee

• Employee's signature on the claim form

• Patient's name

• Other insurance information

• Doctor's signature and tax identification number on the claim form

• Tooth Number

• X-rays if claim is for crowns, root therapy or partials

• Dates of service if claim is for payment, no dates of service if claim is for prior authorization.

• Answer all questions on the claim form