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Forms Library
Below are frequently used forms that your office may use.
- Claim Form
- Customer Specific Claim Form
- NPI Submission Form
- MetLife Salzmann Index Score Sheet
- DPPO Provider Appeals - follow instructions on provider EOB to submit DPPO appeals*
DHMO Forms:
- Direct Referral Form
- Ortho Referral Form (CA Only)
- NPI Submission Form
- DHMO Provider Dispute Form
- MetLife Salzmann Index Score Sheet
*If we deny benefits in whole or in part, you may request a review. This request for review should be sent to MetLife, Group Claims Review, PO Box 14589, Lexington, KY 40512 within 180 days of the date you received notice of adverse determination, and we will respond to that request within 30 days of receipt and provide you with written or electronic explanation of our benefit determination in a manner you can understand.
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File dental claims electronically!
Electronic claim filing
is the fastest method
of getting dental
claims and x-rays processed.
Click here for
information on how to
file electronic claims
with dental insurance carriers.