Claims Coding and Submission Guidelines
ADA Dental Claim Form 2019 Version
(715 KB)
Claims Submission CMS1500
(261 KB)
Claims Submission CMS UB-04
(35 KB)
Register for Electronic Funds Transfer/Electronic Remittance Advice (EFT/ERA)
EFTs send claims payments directly to your bank account, while ERAs make it easier to access and reconcile payment information. EFT and ERA are fast, secure and more accurate than paper checks, and reduce paper waste.
- Log into our provider portal.
- Click the yellow “SIGN UP FOR EFT/ERA” button the landing page.
- Complete the form. The form can take up to 30 days to process.
Contact psinquiries@hpsm.org with any questions.