Home
Forms Library
4 - bPDFb Claimforms HF004 Dental - TLC Insurance

4 - bPDFb Claimforms HF004 Dental - TLC Insurance 2025

4 - bPDFb Claimforms HF004 Dental - TLC Insurance Preview on Page 1

See details

4.3 out of 5

155 votes

The document provides detailed instructions for filing dental claims with Aflac, emphasizing that precertification is not required. It outlines the necessary information to be included on the ADA claim form, such as policyholder details, patient information, treatment specifics, and submission guidelines. Additionally, it mentions conditions for orthodontic and cosmetic riders, and includes a section for claims authorization under HIPAA regulations.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out 4 - bPDFb Claimforms HF004 Dental - TLC Insurance with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the 4 - bPDFb Claimforms HF004 Dental in the editor.
Begin by entering the policy number at the top of the form. Ensure this matches your Dental Plan ID card.
Fill in the policyholder’s complete name as it appears on their Dental Plan ID card, followed by the patient’s full name, sex, date of birth, and relationship to the insured.
Provide details about the treatment: include the treatment date, tooth or surface involved, ADA code, and charges for each procedure performed.
If applicable, indicate if the patient is a full-time student over age 19 and ensure all fields are completed to avoid delays in processing.
Once all information is filled out accurately, save your changes and submit directly to Aflac using their provided address or fax number.

Start filling out your claim form online for free today!

See more 4 - bPDFb Claimforms HF004 Dental - TLC Insurance versions

We've got more versions of the 4 - bPDFb Claimforms HF004 Dental - TLC Insurance form. Select the right 4 - bPDFb Claimforms HF004 Dental - TLC Insurance version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (175 Votes)
2005	4.3 Satisfied (155 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the best way to electronically sign my 4 - bPDFb Claimforms HF004 Dental - TLC Insurance?

Many software applications are available on the market for document editing and signing. DocHub is one of the most widely used online solutions that comply with all security and compliance standards and guarantees your eSigned paperwork is legally enforceable. All you need to give it a try is to register an account, add your 4 - bPDFb Claimforms HF004 Dental - TLC Insurance, provide the requested details, and click Sign. Generate your eSignature by typing, drawing it, uploading its picture to your template, or scanning a unique QR code.

How do you complete 4 - bPDFb Claimforms HF004 Dental - TLC Insurance online?

You may complete and sign your 4 - bPDFb Claimforms HF004 Dental - TLC Insurance on the internet, even on a tight deadline. All you need to access top-notch editing instruments on any device is a DocHub account, that you can register within a couple of moments. Once you register, upload your document or find what you are looking for in our catalog, complete it utilizing the editing instruments you need, and place your electronic signature on it at the end.