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Everything You Need to Know About the ADA Dental Claim Form

The American Dental Association (ADA) Dental Claim Form is one of your major responsibilities when offering or performing dental services. After all, you can’t get paid without it, and patients can’t be reimbursed.

January 17, 2023

ADA policy promotes the use of the most current version of the ADA Dental Claim Form by dentists and payers when reporting services to a patient’s dental insurance plan. ADA Council on Dental Benefit Programs created the form by working with internal and external knowledge experts. Knowing what information this form collects and training your staff is crucial to your practice’s revenue and patient care.

The Current Version of the ADA Dental Claim Form

In the current version of the ADA dental claim 1 , the ADA tried to make things as easy as possible. Staff should be able to complete this form quickly and easily—after all, it’s how your practice pays the bills, so it should be as painless as possible.

Here are some specific items to make sure you’ve properly identified and filled out.

• Boxes 1-2 relate to the type of service and preauthorization number if needed.
• Boxes 3-17 have to do with the patient’s insurance and dental benefit plan information.
• Boxes 18-23 require data from the patient’s intake forms (name, address, etc.)
• Procedure date (Box 24) is the date your practice performed the procedure.
• General area of oral cavity (Box 25) is arranged by numeric codes rather than abbreviations.
• Tooth system (Box 26) — “JP,” or the American system, follows the ADA’s Universal Tooth Designation System with a combination of letters and numbers.
• Procedure codes (Box 29) — add the most appropriate Current Dental Terminology (CDT) procedure code.
• Description of service (Box 30) — this written description should match the code in Box 29.
• Fee (Box 31) — should reflect the usual and customary rate, not the final negotiated rate.

What Do You Need to Know About the ADA Dental Claim Form?

While it’s a process your staff may complete hundreds of times a day, it’s still worth double-checking to make sure everything is perfect with your ADA claim submission to ensure prompt reimbursement. Late payments can be a hassle, and late reimbursements could be devastating to your patients and their families.

Learn more about digital forms by Dental Intelligence to collect the important information in a clear and effective way to make filling out the form as simple as possible. Here are some tips and best practices when filling out the ADA dental claim form:

• Note that Boxes 24-32 may require special instructions in cases where the procedure code (Box 29) is “D9985 Sales Tax.”
• Best practices require you to use JP codes for your tooth system (Box 26), but a value set is available 2 to make mapping international JO numeric codes easy.
• Patients may not always understand the finer points of medical billing, so it’s important to make sure your coding is clear, transparent, and understandable. Patients should feel their needs are met, from the first phone call to the last procedure. Being open about your billing procedures and codes is a great way to support that.
• Make sure to file your claim on time. Delays will only interrupt the payment process and make it harder to complete the forms accurately. You and your staff shouldn’t have to remember everything — not with Dental Intelligence and a full suite of billing tools at your command.
• Make sure the description of service (Box 30) duplicates the procedure code (Box 29) as closely as possible so the insurance provider doesn’t reject the claim. Insurance companies aren’t doing their job if they’re not looking for ways to reject or downgrade claims.

Dental Solutions to Save You Time

The ADA dental claim form shouldn’t be difficult to complete, but it can get complicated. To speed things up, learn more about dental medical history forms with Dental Intelligence to evaluate your current forms.

With Dental Intelligence software, you can conveniently capture patient data sets and simplify the process of submitting claims. Dental Intelligence makes it easy to see exactly where you need to go — and how you’re going to get there — with a full suite of tools, from marketing to appointment setting to payments. Schedule a demo with us today to learn more!