Dental Claim Form Completion Instructions for Members To file the claim: 1. Complete item numbers 1-2, 4-22 and[removed]Attach a signed superbill or statement from your dentist 3. Mail completed form to: BlueCross BlueS - Superbill - Document - PDFSEARCH.IO

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	Dental Claim Form Completion Instructions for Members To file the claim: 1. Complete item numbers 1-2, 4-22 and[removed]Attach a signed superbill or statement from your dentist 3. Mail completed form to: BlueCross BlueS Add to Reading List Document Date: 2011-07-29 13:43:59 Open Document File Size: 110,66 KB Share Result on Facebook City Chattanooga / / IndustryTerm insurance information / insurance company/benefit plan information / out-of-network / / Organization Tennessee Claims Service Center / / Position dentist / / ProvinceOrState Tennessee / / SocialTag Insurance Superbill Risk management information systems Economics Financial institutions Institutional investors Financial economics

Dental Claim Form Completion Instructions for Members To file the claim: 1. Complete item numbers 1-2, 4-22 and[removed]Attach a signed superbill or statement from your dentist 3. Mail completed form to: BlueCross BlueSAdd to Reading List