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Start with Clear, Consistent Documentation to Accelerate the Insurance Verification Process

Free Dental Insurance Verification Form Template

A proven effective and efficient insurance verification document that you can use in your practice.


Download Your Template

Inconsistent insurance paperwork makes collections impossible.

More Consistent Documentation = More Profitability.

Our dental management team has spent the time to develop an industry standard insurance verification form so you don't have to. Use this template to organize and systematize the information your team collects and stores to improve collections, streamline your operations and increase your bottom line.

1. Patient Information

Collect and keep standard patient info including appointment date, name of patient and insurance policy subscriber, social security number and insurance company contact information.

2. Insurance Plan Benefits

Accumulate the relevant features of a patient’s insurance plan such as policy duration, annual max, annual deduction dollar amount, fee schedule, waiting periods and effective date.

3. Frequencies

Track and understand the frequency limitations in a patient’s policy for exams, perio maintenance, sealants and more.

4. Downgrades

Record whether composites, posterior crowns, surgical placement of implants or nightguards have been downgraded. 

5. Insurance Claim Verification

Notate important insurance claim information including claim mailing address and payor ID number.


Dental Insurance Verification Form Template

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