Free Basic Claim Analysis Form

1. Submit Your Details to  freebca@globaldentalclaims.com

If you are a patient: If you are a provider you should include your Provider Office details. Such as:

Facility name, Address of facility. Treating Provider Name. 

for basic claim analysis TaxId OR NPI is not needed, but for eligibility verifications will be required.

Complete the form with the following information to get started:

• Full Name (Required): 

So we know who to contact.

• Email Address (Required): 

This is where we’ll send your personalized analysis.

• Policy Number (Optional):

Helps us tailor the review to your specific claim.

• Brief Description (Required): 

Share a quick explanation of the dental treatment or claim issue you'd like us to analyze.

• Supporting Documents (Required): 

Upload the following if available:

• • Claim Form: Helps us understand the full details of your submission.

  • Denial Letter: Provides clarity on the issue and denial reason.

  • Procedure Code (PEC Code): Ensures accurate analysis of the claim.

If additional details are needed, we may reach out to clarify during the process. Be sure to review our Terms and Conditions for full details about the process.