Transcription of ADA Dental Claim Form Instructions
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ADA Dental Claim Form Instructions
Page 1 of 1 Fact Department of veterans AffairsVeterans Health AdministrationOffice of Community Care IB-10-1368 COMMUNITY CAREC reated Date: September 26, 2019 VHA Office of Community CareADA Dental Claim form InstructionsThe following information highlights certain VA specific form completion Instructions . Comprehensive ADA Dental Claim form completion Instructions can be found on the ADA s web site ( ).General Instructions1. All yellow highlighted fields are required to be completed accurately and fully. Incomplete or erroneous information will result in Claim rejection. Yellow highlighted fields include the following sections:a. Header Information; fields 1 and Policy Holders/Subscriber Information; fields 12 through 15.
Page 1 of 1 Fact Sheet. U.S. Department of Veterans Affairs. Veterans Health Administration. Office of Community Care . IB-10-1368—COMMUNITY CARE Created Date: September 26, 2019
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