rayant  
 
Find a Dentist    About Rayant    Site Map    Contact Us   
 
 
 
 
 

Help and Resources

Downloadable Forms



Provider Verification Form (5632)

Signature on File Dentist Authorization Form (5631)

Authorization Agreement for Automatic Deposits (5601)

Electronic Funds Transfer Letter (5593)

VerifPoint Form (1091)

Provider Change Form (4289)

Professional Questions and Attestation (12005)

PA Traditional and PPO Application Checklist (5626)

PA Agreement with Participating Dentists (1437)

PA PPO Amendment (5583)

NY and PA PPO Orthodondic Fees (5630)

NY Agreement with Participating Dentists (9582)

NY PPO Amendment (5582)
Electronic Claims Submission

A simple and easy way to file your claims.

Learn why you should submit claims electronically.

Dental Consultant Corner

Read our quick guide to submitting your claims and preauthorizations.
SITE MAP    TERMS OF USE    PRIVACY POLICY     

In New York, products are underwritten by Rayant Insurance Company of New York. In Pennsylvania, products are underwritten by Rayant Insurance Company of Pennsylvania.
© 2007