Updated essential health benefit orthodontic forms

Q2 Word of Mouth newsletter 2023

We recently updated the essential health benefit (EHB) orthodontic forms and have redesigned our provider portal to make it easier for you to find them. You can find the EHB forms by visiting the Claims and Pre-Treatment Estimates page and clicking the EHB Orthodontic forms under the Claims Resources.  

To avoid delays in processing your EHB orthodontic claims, complete the following steps: 

  • Select the appropriate state form specific to the subscriber’s group state of issue and plan name shown on the member’s ID card
  • Fill out the applicable form in full
  • Attach required documentation
  • Submit with completed dental claim form for review of medical necessity