Dc37 dental forms 2026

1. Click ‘Get Form’ to open the dc37 dental form in the editor.
2. In the Policy Holder/Subscriber section, complete all required fields from boxes #4 to #23. Ensure that all information is accurate to avoid processing delays.
3. If you are the member, patient, or guardian of a minor, fill out box #36 by providing the date and either your signature or indicating 'signature on file.'
4. Complete box #37 to authorize payment directly to your dentist.
5. For the dentist section, enter all necessary details including your social security number or tax ID and full address.
6. List all procedures and fees separately in the treatment area. Include tooth numbers, quadrant codes, and total amounts in box #32. Only CDT codes are accepted in column #29.
7. Attach any required mounted x-rays along with your request for pre-authorization or claims for completed services.
8. To expedite processing, submit claims electronically via Secure EDI at https://www.secureedi.com/securetrack/home.aspx or send paper claims to DC 37 Health and Security Plan at 125 Barclay Street, New York, N.Y. 10007.

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