New dental claim forms are now available at the DC 37 Health and Security Plan office. The new form is one page, with information about filing claims on the back in English and Spanish. The form has two sections, one to be completed by the member and the second to be completed by the dentist. All required signatures are now at the bottom of the claim. The member and dentist sign only one box, whether the request is for a pre-authorization or a claim for completed services.

For completed services, members must check a box to indicate whether the payment should go to the member or dentist. The plan will continue to accept and process the old claim forms until they run out.

You can request forms from the plan’s Inquiry Unit on the Forms Only line, 212-815-1531. You can also download a paper copy of the new dental claim form by clicking here. (PDF)*