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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.  
(Use the forms below for Dental Prime or Dental Complete plans with effective dates before October 1, 2015.)  
Group Implementation & Enrollment  
Census Enrollment Spreadsheet
Group Administration Manual
 
Member & Group Forms 
Membership Enrollment Form
Membership Enrollment Form – Spanish
Membership Maintenance Form
Authorization to Release Information
Authorization to Release Information - Spanish
Disabled Dependent/Michelle’s Law Application
 
Additional Benefits Forms 
International Emergency Dental Program Flier
International Emergency Dental Program Frequently Asked Questions
Extra Cleaning Form for Pregnant and Diabetic Members
 
Online Services 
Online Capabilities Flier
Online Enrollment Billing Reports Request Form
Dental Employer Online Services Demo
 
Group Billing Forms 
Monthly Fully Insured 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.