At a glance
- Start by confirming the plan or payer and the person who holds the coverage.
- Verify the patient's identifying information against the practice record and the coverage information being used for this claim.
- Review procedure dates, CDT procedure codes, tooth or oral-cavity information when applicable, fees, and related treatment details as a group.
Plan and subscriber information
Start by confirming the plan or payer and the person who holds the coverage. A common source of rework is mixing patient information with subscriber information when the patient is a spouse or dependent.
Patient information
Verify the patient's identifying information against the practice record and the coverage information being used for this claim. Small mismatches in name, date of birth, or identifiers can matter to a payer.
Treatment and procedure information
Review procedure dates, CDT procedure codes, tooth or oral-cavity information when applicable, fees, and related treatment details as a group. The claim should reflect the services actually documented.
Provider and authorization information
Confirm treating and billing dentist information, identifiers, addresses, and any signatures or authorizations that apply to the claim. Different dental plans can have additional requirements.
Dental-claim review
- Review the form by information group: transaction/payer, other coverage, subscriber, patient, services, consent, ancillary information, billing entity, and treating dentist.
- Use the 2024 ADA completion instructions when a field’s purpose is unclear.
- Do not treat a blank field as an error until you verify whether the field applies to the claim.
Sources and verification
Use the ADA source below for the current 2024 Dental Claim Form and completion guidance, together with the dental plan’s requirements.
Related guides
- What Is the 2024 ADA Dental Claim Form?
- Printing the 2024 ADA Dental Claim Form
- Patient Information on the ADA Dental Claim Form
Try the software
MedClaimSoftware’s ADA Dental Claim program is designed for the current 2024 form and can save/retrieve claim data and print from Windows. A limited-use trial is available without a credit card. ADA Dental Claim software.