Dental (DN)
There are two sets of forms available, those for which we have samples, and those that are Submitter supplied with no defined format.
There is currently one exception to this service: Photos / X-rays - please send these via email to HnDental@acc.co.nz.
| Click on a link for available sample | |
| ACC001 | Request for Assistance |
| ACC37 | Tax Invoice for Treatment |
| ACC42 | Injury Claim Form (includes Amendments & Late Lodgements) |
| ACC1345 | Request for Prior Approval of Simple Dental Treatment |
| ACC2303 | Request for More Information on Dental Claim |
| ACC4231 | Orthodontic Treatment Prior Approval |
| ACC8298 (replaces ACC899) | Dental Assessment Report and Treatment Plan (DARTP) |
| No link present means Submitter format applies |
| Consent Form |
| Invoice - Componentry |
| Invoice - Non specialists |
| Invoice - Specialist |
| Invoices / Receipts - from Claimant |
| Late Lodgement Questionnaire - from Claimant |
| Late Lodgement Questionnaire - from Provider |
| Letter - from Client |
| Letter - from Provider |
| Medical Records / Notes |
| GA Prior Approval - via Letter |
| Prior Approval Application - for Specialist Dental Treatment |
| Prior Approval - via Letter |
Software Vendor Resources
Should you, as a software vendor, want to know more have a look at Resources for Software Vendors of Dentists
Support
If you have any questions, or would like to know more, please feel free to contact us.