COMPLYRIGHT ADA Dental Claim Forms (2024) - Letter (8-1/2" x 11"), Laser Printed, Carbonless

The ADA Dental Claim Forms (2024) provide a standardized format for reporting dental services to a patient's dental benefit plan. Developed by ADA Practice Institute staff with contributions from the ADA Council on Dental Benefit Programs and other governing agencies, the 2024 version adds spaces for Payer ID and for identifying services performed by a locum tenens to support timely and accurate reimbursement. These laser-printed, carbonless, double-sided letter (8-1/2" x 11") forms adhere to strict ADA printing standards governing layout, paper and ink. Product details from the printed specification include acid free paper, cut-flush binding, black ink, single-part format, and no sensor bars. Designed to conform to ADA guidelines and HIPAA requirements, the forms support consistent, professional dental billing and claims submission.

• PACK SIZE: 2,500, 8-1/2" X 11" laser printed claim forms
• COMPLIANT: Forms adhere to strict printing standards that govern the layout, paper and ink. 100% compliant to meet ADA guidelines
• PROFESSIONAL: 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
• CLAIM FORM: 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).
• IMPORTANT: Starting January 1, 2024, providers and dental industry partners will see crucial updates designed to streamline dental claims processing.