Dental
Dental Claim (Dental Service Report)
Use this form to file a Horizon Dental plan claim or to request an up-to-date report of a member∍s dental benefits so they can plan for future dental expenses.
ID: 7902 (W1105)
Authorization for Disclosure of Protected Health Information (PHI) - Dental Only
Use this form to authorize the use and disclosure of a member∍s dental Protected Health Information that is held by Horizon BCBSNJ and its business associates.
ID: 5418 (W0212)
Dental Recruiting Request Form
Give this form to a dentist to invite him/her to join one or more Horizon BCBS dental networks.
ID: 9652
