Health Choice Arizona -- Providers

Dentists

ADA Dental Claim Form Update

The ADA Dental Claim Form provides a common format for reporting dental services to a patient’s dental benefit plan.

The latest version of the ADA dental claim form becomes valid for use on January 1, 2007. The claim form enables reporting of a National Provider Identifier (NPI), in addition to a current proprietary provider identifier, for both the Billing Dentist/Dental Entity and for the Treating Dentist.

Samples of the ADA Dental Claim Form are available for review:
http://www.ada.org/2622.aspx?currentTab=2

Source: American Dental Association, www.ada.org

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Copyright © 2006. Health Choice Arizona, 410 N. 44th Street, Ste. 900 Phoenix, AZ 85008 Last Update 10/29/2008. Health plan services are funded in part through a contract with AHCCCS and the State of Arizona. Copyright © 2006. Health Choice Arizona, 410 N. 44th Street, Ste. 900 Phoenix, AZ 85008 Last Update 10/29/2008. Health plan services are funded in part through a contract with AHCCCS and the State of Arizona.