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Submit a Claim
- For Quality and Comprehensive Members only
Making a claim is simple:
By fax.
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Click here to download a claim form.
The claim form is in Adobe® PDF format. If you to not have Adobe® Acrobat Reader®, which will enable you to view and print the claim form, click here to download a free copy.
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Complete the form and be sure to sign it.
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Fax the completed, signed form, along with the receipt for the dental services you are claiming, to 1-866-369-0705.
By mail.
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Click here to download a claim form.
The claim form is in Adobe® PDF format. If you to not have Adobe® Acrobat Reader®, which will enable you to view and print the claim form, click here to download a free copy.
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Complete the form and be sure to sign it.
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Mail your completed, signed form, along with a copy of the receipt for the dental services you are claiming, to:
deneX Claims Processing
c/o EPSI
P.O. Box 926049
Houston, TX 77292-6049
Value dental is not insurance. It is a discount program. You are responsible for the full cost of any health care services purchased. You will receive discounts for medical services at certain health care providers who have contracted with the plan. denex value does not make payments directly to health care providers. This program is administered by Group Dental Service of Maryland, Inc. (GDS-MD), your Discount Medical Plan Organization, 111 Rockville Pike, Suite 950, Rockville, MD 20850, (240) 283-3500
www.denexvalue.com. The program and its administrators have no liability for providing or guaranteeing service or the quality of service rendered.
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