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Alberta dental hygiene claim form 2025

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The document is a National Dental Hygiene Claim Form from the Canadian Dental Hygienists Association, designed for registered dental hygienists to submit claims for services rendered. It includes sections for patient information, service details, and authorization for payment. The form emphasizes the need for accurate completion and confidentiality of the information provided.

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Click ‘Get Form’ to open the Alberta Dental Hygiene Claim Form in the editor.
Begin with Part 1, where you will enter the Registered Dental Hygienist's details. Fill in the last name, first name, address, city, province, postal code, and telephone number.
Next, provide the Date of Service by selecting the day, month, and year. Ensure accuracy as this is crucial for processing your claim.
In the section labeled 'Registered Dental Hygienist Use Only', input the office number and CDHA UIN #. Include any relevant service codes and tooth codes as applicable.
Detail the services provided along with any laboratory charges. Make sure to calculate and enter the total cost accurately.
Proceed to Part 2 to fill in your personal information as an employee or plan member. This includes your group policy number, date of birth, and gender.
In Part 3, if applicable, provide client/patient information including their relationship to you and any other insurance details that may apply.
Finally, review all entered information for accuracy before signing at the bottom of each relevant section. Once completed, submit your claim form as instructed.

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

How to correct a dental claim?

Provide Corrected Information: Ensure that all errors are corrected in the new submission, and all necessary information is accurately provided. records. Include any other supporting documentation that supports the treatment, even if you submitted it initially on the incorrect claim.

How do I submit a dental claim to Alberta Blue Cross?

Your dental claims may be submitted online through the member website, or you may download a PDF Dental claim form and mail it, with your receipts, to Alberta Blue Cross.

What claim form is used for dental services?

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.

Is Alberta Blue Cross the same as Blue Cross?

Like the five other Blue Cross plans in Canada, ABC Benefits Corporation operates the Alberta Blue Cross Plan in compliance with the licensing requirements of the Canadian Association of Blue Cross Plans.

Does Alberta Blue Cross cover any dental?

Basic dental services covered include the following: Cleanings and preventative services, such as polishing and scaling. Restorative services, such as fillings and trauma or pain control. Extractionsboth simple and complicated. Root canals (endodontics).

How much do dental hygienists make per hour in Alberta?

As of Sep 11, 2025, the average hourly pay for a Dental Hygienist in Alberta is $39.55 an hour. While ZipRecruiter is seeing salaries as high as $55.53 and as low as $21.15, the majority of Dental Hygienist salaries currently range between $33.65 (25th percentile) to $44.71 (75th percentile) in Alberta.

How to file a BCBS dental claim?

Download and fill out the claim form at bcbsfepdental.com/claimform. Log in to the secure member portal at bcbsfepdental.com. Head to the My Documents tab, click Submit a Claim and select the claim form you saved. Make sure you only submit one claim form at a time and any supporting documents.

Alberta dental hygiene claim form 2025

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