Forms

Appointment of Authorized Representative Form (9k)
Provider nomination
NO DENTAL CLAIM FORM IS NEEDED
To request payment for a service you received and paid at the time of your dental visit, simply send the provider's itemized receipt to the claims address on the back of your ID card. Before mailing, be sure you include the patient's name and the HumanaDental member's name and ID number on the itemized receipt. If you have questions regarding these instructions, call us toll-free at (877) 377-0987 or 711 for TDD.