Cdha claim form 2026

1. Click ‘Get Form’ to open the cdha claim form in the editor.
2. Begin with Part 1, where you will enter the Registered Dental Hygienist's details. Fill in the CDHA UIN #, last name, first name, address, city, province, postal code, and telephone number.
3. Next, provide the Date of Service and CDHA Service Code. If applicable, indicate if preauthorization is required and detail the dental hygienist’s fee along with a description of services provided.
4. In Part 2, input your Employee/Plan Member/Subscriber information including Group Policy/Plan No., date of birth, and gender. Ensure all fields are accurately filled.
5. Proceed to Part 3 for Client/Patient Information. If different from the claimant, provide their relationship to you and any relevant details regarding other insurance plans or accidents.
6. Finally, review all entries for accuracy before signing at the bottom of each section. Once completed, submit your claim as instructed.

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