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In this video, Ill be demonstrating how to fill out the top portion of a dental insurance claim form for Hugh Morus. So youre going to start with the very first box in the upper-left hand corner of the form titled header information. In this box, youre going to select the box that says statement of actual services. Then you can press the tab key and next your way through to the next area that needs to be filled in. The authorization number in box number two does not need to be filled in. You can go ahead and type in N/A for not applicable. In box number three this is for the insurance company information and we know that Hugh has Prudential insurance through his employer. Youre going to type Prudential insurance in box number three also with Prudentials address which we know is P.O. Box 807. City is New York. New York with a zip code of 00216. So the next box area 4 through 11 is for other coverage so if Hugh was to have if he came had a dual coverage
