Dental Care Alliance (DCA) - Office Enrollment Form
PLEASE COMPLETE THE FORM BELOW TO ENROLL YOUR PRACTICE
We will also send you a Business Associates Agreement (BAA) to be completed before activation.
When the Office Enrollment & BAA have been received, we will send you a welcome packet to be emailed within 2-3 days.
Next, we will plan your onboarding:
Training #1 - Pristine Medical Billing Model: We will educate you on how to create your fee schedule for medical insurances.
Training #2 - We will educate you on what documentation is needed from your team to appropriately bill medical insurances.
Please call (844) 597-7617 or email info@PristineMedicalBilling.com if you need any assistance with the following form.