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Dental Prime and Dental Complete Employer Services

PW_E167936
 
Post-sale questions?  Call Employer Services, 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
 
Pre-Sale Materials  
Employer Flier
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 Services 
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.