The 2024 ADA Dental Claim Form has been structurally revised to incorporate data content changes. Effective 1/1/24 this should be the only form being used and the 2019 form will be discontinued.
The ADA has made 5 changes to the 2024 ADA Dental Claim Form, including the following
- Line 1. New placement of Text and Boxes
- Line 3a. PayerlD: Enter the Payer Identification number for the company plan specified in “3” – above. (Leave blank if not known.)
- Line11 a. Other Payer ID: Enter the Payer Identification Number for the Other Insurance Company/Dental Benefit Plan specified in “11.” above. (Leave blank if not known.)
- Line 39a Completion instructions for new field to report date of patient’s last Scaling and Root Planing procedure (MM/DD/CCYY format).
- Line 53a Enter a “Y” in the box to indicate whether or not the treating dentist is providing services is a locom tenens capacity. (Leave blank if not applicable)
These New forms will be on the shelf in November at the same great price as the current forms.