UHC Dental Claim Form - NCRetiree - op-f 2025

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This is done using box #37 on the ADA claim form. The below image shows the specific instructions for how to complete box #37 for use with assignment of benefits. even though the patient has signed the appropriate section of the dental claim form.
Claims Department UnitedHealthcare Life Insurance Company AMS PO Box 31375 Salt Lake City, UT 84131-0375 EDI #81400 AMS Claims Fax (801) 478 7582 (Medical, Dental, Drug, Accident, Disability claims can be faxed here.)
Most often, your dentist will submit a claim for you, but if you need to do so, please send it to: UnitedHealthcare, Attn: Claims Unit, P.O. Box 30567, Salt Lake City, UT 84130-0567.
When youre looking for a plan thats right for your needs and your budget, UnitedHealthcare branded dental plans, underwritten by Golden Rule Insurance Company include a variety of options to meet your needs. Read on to learn more about how dental coverage and benefits work.
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Submit your claim by mail After you print and complete the Medical Claims Submission form, mail it with the claim details and receipts to the address on your health plan ID card.
The ADA Dental Claim Form provides a common format for reporting dental services to a patients dental benefit plan. ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers.