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A total-health solution that surrounds everyone with the help they need to live healthier, feel better and save money doing it.
Dental Prime and Dental Complete Employer Services
Post-sale questions? Call
, a division of Customer Service, at 877-567-1799. Press 1 for Billing, 2 for Enrollment, 3 for Group Administrator Helpline.
Dental Prime and Dental Complete Tools
(log on to access online enrollment and billing reports)
Group Implementation & Enrollment
Group Master Application with Submission Requirement Checklist (for groups 2-50)
Census Enrollment Spreadsheet
Group Administration Manual
Plan Designs (Groups 2-50)
Plan Designs (Groups 51+)
Member & Group Forms
Membership Enrollment Form
Membership Enrollment Form – Spanish
Membership Maintenance Form
Authorization to Release Information
Authorization to Release Information - Spanish
HIPAA Designated Contact Form
Disabled Dependent/Michelle’s Law Application
Additional Benefits Forms
International Emergency Dental Program Flier
International Emergency Dental Program Frequently Asked Questions
Extra cleaning sign up form for diabetic and pregnant members
Online Capabilities Flier
Online Enrollment User Request Form
Billing Reports Online User Request Form
Billing Reports Online Change Request Form
Group Billing Forms
Monthly Fully Insured Billing Schedule
Weekly ASO Billing Schedule
Automated Fully Insured ACH Authorization Form
Automated ASO ACH Authorization Form
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.