Revised ADA Claim Form

November 16th, 2012

The ADA Dental Claim Form has been revised to incorporate key changes to the HIPAA standard electronic dental claim transaction. Some of the changes include the reporting of diagnosis codes and diagnosis code pointers, Place of service codes, and other medical and dental coverage.

The new ADA claim form will support reporting up to four diagnosis codes per dental procedure. According to the claim form instructions, "a diagnosis code will be required when the diagnosis may affect claim adjudication when specific dental procedures may minimize the risks associated with the connection between the patient's oral and systemic health conditions." The required Place of Service Codes will be the same Place of Service Codes required on medical claim forms.

The AAOMS encourages members and their staff to start to work with their vendors now so that their systems and claims are ready for January 1st. The revised ADA Dental claim form and complete instructions may be found on the ADA website at http://www.ada.org/7119.aspx.