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Anthem Blue Cross : Dental Prime and Complete Employer Services

Dental Prime and Complete Employer Services

PW_E169220
 
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 Help Line.  
(log on to access online enrollment and billing reports)  
 
Group Implementation & Enrollment 
Group Master Application (for groups 2-50)
Sold Case Checklist (for groups 2-50)
Census Enrollment Spreadsheet
Dual Option Dental Enrollment Verification Form
Group Administration Manual
 
Member & Group Forms 
Membership Enrollment Form
Membership Enrollment Form – Spanish
Membership Enrollment Form – Chinese
Membership Enrollment Form – Vietnamese
Membership Maintenance Form
Authorization to Release Information
Authorization to Release Information - Spanish
HIPAA Designated Contact Form
Disabled Dependent/Michelle’s Law Application
Cal-COBRA Continuation Coverage Election Form (for groups of less than 20)
 
Additional Benefits Forms  
International Emergency Dental Program Flier
International Emergency Dental Program Frequently Asked Questions
Extra Cleaning Sign-Up Form For Diabetic and Pregnant Members
 
Online Services 
Online Capabilities Flier
Online Enrollment Billing Reports User Request Form
Dental Employer Online Services Demo
 
Group Billing Forms 
Monthly Fully Insured Billing Schedule
Weekly ASO Billing Schedule
Automated Fully Insured ACH Authorization Form
Automated ASO ACH Authorization Form
 

® Anthem is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association © 2011 Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.