LIFE INSURANCE CLAIM APPLICATION FORMS INSTRUCTIONS ALL OF THE FOLLOWING PROPERLY COMPLETED FORMS ARE ESSENTIAL TO THE PROMPT PROCESSING OF YOUR CLAIM: INFORMATION RELEASE FORMS Guide: Use a ballpoint pen to complete the form and follow the guidelines mentioned below: GUIDELINES Section full controlled if you use the contract Unfortunately, because the porters did not implement v4, or implemented it correctly in the case of Sun Life, some dentists will simply indicate the dentist`s “count” to facilitate business processes in their offices. This goes against the planned functionality. Note that some dentists now use direct payment services by porters, so the claims correctly indicate the dentist treating, and the payment is deposited into the account that is preferred by the senior dentist. 11 The damage processor does not resolve late claims electronically. Dental practices must not submit the same fee twice. If the claim has been successfully sent, you will receive an explanation of the benefits for claims processed in real time or a claim confirmation if the claim is processed in batch mode. These forms must be printed automatically in your office. If not, contact your software company. If a third party decides on a claim in real time, the resulting EOB will be returned electronically to you shortly after the application is filed. An EOB is printed for an unassigned claim. For an assigned claim, your computer system can print two EOBs, one for you and one for the patient, or one EOB for the patient. You can also contact your software publisher to organize one or more impressions from your system. The declaration of benefits or confirmation of rights must be given to the patient before leaving the dental office.

Patients should always receive this to receive the procedures performed before leaving the dental office. Inform your patients that all questions about calculating benefits should be directed to the person responsible for the damage. A cheque is sent to the insured or directly to the dentist for the benefits transferred. An example of EOB will be displayed on the next page. 8 2 Table of Materials Introduction to CDAnet… 1 What is CDAnet ?… 1 How does CDAnet affect my computer system?… 1 Will the office procedure change?… 1 rules and regulations…

3 CDAnet Launch Date… 3 patient`s permission… 3 patient information… 3 Electronic submission of aged rights… 4 Explanation of benefits and confirmation of rights… 4 Subscribe to a dentist on CDAnet… 4 How and when CDAnet advises office information, changes… 4 members… 5 Prohibited practices…

5 cdAnet deposit bases: understand your responsibilities… 6 claims… 7 Request in real time Treatment… 7 batch transformations… 7 To file a claim… 7 Example – explanation of the benefits form… 9 Explanation of the title of the Benefit Form Confirmation of Claim Sample request. Confirmation Form Form Employer Title Certified Claims Sample – Employer Certified Form Titles Form Positions Of Form Cancel a Claim: Pended Claims/Request for Outstanding Transactions Pre-Processing Plans (Predetermination) To submit a Pre-treatment Plan Coordination of Benefits Coordination of Benefits for Version Coordination of Benefits for Version 4 Claimits Sample – Plain Paper