Page 3 - GDP - Provider Reimbursement Guide B 2022
P. 3
Table of
Contents
Page
Golden Dental Plans Reimbursement and Billing Guidelines . . . . . . . . . . . . . . .2 – 3 Schedule of Benefits and Monthly Payments . . . . . . . . . . . . . . . . . . . . . . . . . . .5 – 9 Supplemental Payment Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 – 15 Specialty Authorization Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Golden Dental Plans Contact Information . . . . . . . . . . . . . . . . . . . . . . . .Back Cover
