Introducing the New 2024 ADA Dental Claim Form

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

1.  Line 1. New placement of Text and Boxes
2. Line 3a. PayerlD: Enter the Payer Identification number for the company plan specified in “3” – above. (Leave blank if not known.)
3. 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.)
4.  Line 39a  Completion instructions for new field to report date of patient’s last Scaling and Root Planing procedure (MM/DD/CCYY format).
5. 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.