ComplyRight® ADA Dental Claim Forms (2024 Version), Laser, 8-1/2″ x 11″, Box Of 2,500 Forms

As of January 1, 2024, the ADA released an updated version of the ADA Form that now provides new spaces for reporting specific data that can expedite timely and accurate claim reimbursement. The 2024 version also makes it now possible to clearly identify claims for services delivered by a “locum tenens” dentist, one who is standing in for another who is away from the practice for a short time. The form also supports reporting an identifier, known as Payer ID, that when available uniquely identifies the third-party payer receiving the claim. ComplyRight Dental Claim Forms allow healthcare providers to bill a patient’s insurance company for reimbursement of dental claims. These forms have accurate content and conform to the Health Insurance Portability and Accountability Act (HIPAA). Developed in conjunction with all the governing agencies, including the National Uniform Claim Committee (NUCC), the National Uniform Billing Committee (NUBC), the CMS Centers for Medicare and Medicaid Services, the Health and Human Services Agency, and the American Hospital Association.

• The ADA Form provides a common format for reporting dental services to a patient’s dental benefit plan. ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers.
• The following materials are prepared by the ADA Practice Institute staff with contributions from the ADA Council on Dental Benefit Programs and other internal and external knowledge experts.
• The form also supports reporting an identifier, known as Payer ID, that when available uniquely identifies the third-party payer receiving the claim.
• Forms adhere to strict printing standards that govern the layout, paper and ink. 100% compliant to meet ADA guidelines.
• Laser Form
• 8-1/2″ X 11″