Enrollment Forms - Dental Real-time
Additional Enrollment The below payers require Dental providers to complete an additional enrollment process before they may submit their Real Time transactions electronically. For each payer listed below which you would like to submit electronic Real Time transactions to please click on the carrier name and download the additional enrollment packet. Enrollment varies by payer please follow the instructions as written. Please ensure all necessary information is accurate and all required signatures are present. If you require assistance completing an enrollment process or have questions please contact Emdeon Dental Provider Enrollment at 888-255-7293 option 1.All enrollment forms are in Adobe Acrobat® format (.pdf). Ifyou do not have Adobe Acrobat® Reader™, you may download it here. |
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ALL DOCUMENTS MUST BE PRINTED WITH 'DOCUMENTS AND MARKUPS' OPTION IN PRINT DIALOG (DEFAULT IS ONLY 'DOCUMENT') TO ENSURE PROPER PRE-FILLING OF FORM DATA |
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