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Anthem Dental Prime and Anthem Dental Complete Employer Services

PW_B144909
Post-sale questions? Call Employer Services, a division of Customer Service, at 877-567-1799. Press 1 for Billing, 2 for Enrollment, 3 for Group Administrator Helpline. 
 
Anthem Dental Prime and Anthem Dental Complete Employer Tools  
Anthem Dental Prime and Anthem Dental Complete Employer Tools

(log in here to access online dental enrollment and billing reports)

 
Group Enrollment and Implementation Forms 
Group Master Application (for groups 2-99)
Submission Requirement Checklist (for groups 2-99)
Census Enrollment Spreadsheet
Group Administration Manual
 
Member & Group Forms 
Membership Enrollment Form
Membership Enrollment Form - Spanish
Membership Maintenance Form
Authorization to Release Information
Authorization to Release Information - Spanish
HIPAA Designated Contact Form
Disabled Dependents/Michelle's Law Application
 
Additional Benefits Forms 
International Emergency Dental Program Flier
International Emergency Dental Program Frequently Asked Questions
Clinical Integration Slick
Extra cleaning sign up form for diabetic and pregnant members
 
Online Services 
Online Capabilities Flier
Online Enrollment User Request Form
Billing Reports Online User Request Form
Billing Reports Online Change Request Form
 
Group Billing Forms 
Monthly Fully Insured Billing Schedule
Weekly ASO Billing Schedule
Automated Fully Insured ACH Authorization Form
Automated ASO ACH Authorization Form
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use