Dental

Automated Clearinghouse Authorization Agreement

Automated Clearinghouse Authorization Agreement. ID: 8897

This form is used by dental providers to update their file maintained by Horizon BCBSNJ. ID: 2813

This is a Dental claim form used by the dental provider for patient encounters. ID: 2954

This form is used by New Jersey dental providers to apply to Horizon BCBSNJ’s networks. ID: 32227

Dental Recruiting Request ID: 9652

National Provider Identifier (NPI) Collection Form - Dental Group/Practice ID: 19708

National Provider Identifier (NPI) Collection Form - Individual Dentist ID: 19707

Dental providers use this form as a referral for orthodontic authorizations. ID: 8079

Dental providers use this form as a referral for specialty periodontal authorizations. ID: 1649

Dental providers use this form as a referral for specialty service authorizations. ID: 8083