Dental Provider Forms

Commonly Used Forms and Documents

Dental Provider Network Guide Here are some examples of our members' ID cards. You can also find details about how to submit claims and contact Customer Service.
Dental Provider FAQ Answers to the Top 10 questions asked by Dental Providers can be found in this guide.
Dentemax Recognition Information For providers that are contracted through Dentemax, United Concordia, Careington, Connections Dental, and Maverest: this document explains the relationship AlwaysCare/Unum has with your practice office through the leasing agreements in place with these networks.
W9 (10-2018) Request for Taxpayer Identification Number and Certification, W9 Form (Oct. 2018). Form fillable PDF document you can fill, print, save and send via email.
ADA Dental Claim Form 2012 American Dental Association Claim Form, version J430D, 2012. Please use this form to submit your claims. Form fillable PDF document you can fill, print, save and send electronically or via US Mail.
Tips for ADA Claim Form 2012 Guide to help with faster claim processing and payment when using the ADA Claim Form 2012.
Dental Claim Form Dental Claim form
Grievance Form Grievance form
Add/Term Form **NEW FORM** Add or remove doctors and/or locations from your practice records. Form fillable PDF document you can fill, print, save and send via email.
Records Change Form **NEW FORM** Update your Tax ID, practice name, phone number, address, provider name changes, and more! Form fillable PDF document you can fill, print, save and send via email.
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