About LIBERTY Dental Plan
 

Member Transfer Request

For member use only. Providers are prohibited from submitting member transfer requests.

Step 1: Search for Provider Office

Select Benefit Plan

Benefit Plan

Enter Location

Step 2: Select Provider Office to be Assigned

Dentist NameOffice LocationMore InfoSelect

Step 3: Enter Member Details

OFFICE DETAILS


MEMBER DETAILS

Yes

By clicking “Submit”, I affirm that I am a member of Empire BCBS HealthPlus, BCBS of Western New York or Amerigroup NJ. I acknowledge that use of this form by anyone other than the member named above is considered potentially fraudulent and may be subject to corrective action by the Plan.

Please only click Submit once