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APPLICATION FOR RESTRICTED DENTAL LICENSE
www.lsbd.orgRestricted dental license application information and instructions 3 Rev. 6/26/2018 DOCUMENTATION TO BE SUBMITTED WITH YOUR APPLICATION Please use the following checklists to ensure your application is complete prior to your submitting it to your
Claim filing requirements - HealthEquity
resources.healthequity.comREAD BEFORE SUBMITTING YOUR REIMBURSEMENT FORM. DO NOT FAX THESE INSTRUCTIONS WITH YOUR REIMBURSEMENT FORM. Required information for reimbursement The IRS requires you to substantiate all claims with documentation. The documentation must detail the expenses and include five key data points: 1. Name of provider …