ComplyRight ADA Dental Claim Forms (2024 Version), Laser, 8-1/2in x 11in, Box Of 1, 000 Forms MPN:202411

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In Stock
Brand: R & R
Part #: 202411
UPC: 790757381681
SKU
312-9876172
ComplyRight ADA Dental Claim Forms (2024 Version), Laser, 8-1/2in x 11in, Box Of 1, 000 Forms MPN:202411

ComplyRight ADA Dental Claim Forms are essential for healthcare providers to bill patients' insurance companies for dental claims. These 100% compliant forms adhere to strict printing standards and are developed in conjunction with governing agencies, including the ADA, NUCC, and CMS. They provide a common format for reporting dental services and support reporting specific data to expedite timely and accurate claim reimbursement. Ideal for use in dental offices, these forms enable healthcare providers to efficiently submit claims and receive reimbursement for services. They are perfect for any dental practice looking to streamline their billing process and improve reimbursement rates.

Top product features:

  • Acid Free: Yes
  • Carbonless: Yes
  • 100% compliant with ADA guidelines

Top product applications:

  • Healthcare Providers
  • Office Administrators
  • Insurance Payers
As of January 1, 2024, the ADA released an updated version of the ADA Form that now provides new spaces for reporting specific data that can expedite timely and accurate claim reimbursement. The 2024 version also makes it now possible to clearly identify claims for services delivered by a locum tenens" dentist, one who is standing in for another who is away from the practice for a short time. The form also supports reporting an identifier, known as Payer ID, that when available uniquely identifies the third-party payer receiving the claim. ComplyRight Dental Claim Forms allow healthcare providers to bill a patients insurance company for reimbursement of dental claims. These forms have accurate content and conform to the Health Insurance Portability and Accountability Act (HIPAA). 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. The ADA Form provides a common format for reporting dental services to a patients dental benefit plan. ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers. The following materials are prepared by the ADA Practice Institute staff with contributions from the ADA Council on Dental Benefit Programs and other internal and external knowledge experts. The form also supports reporting an identifier, known as Payer ID, that when available uniquely identifies the third-party payer receiving the claim. Forms adhere to strict printing standards that govern the layout, paper and ink. 100% compliant to meet ADA guidelines. Laser Form 8-1/2in X 11in

Features

  • Acid Free: Yes
  • Binding Type: Cut-Flush
  • Brand Name: ComplyRight
  • Carbonless: Yes
  • Claim Type: ADA Dental
  • Color (Ink): Black
  • Double Sided: Yes
  • Manufacturer: R & R VENTURES
  • Number of Parts: True
  • Quantity: 1000
  • Sensor Bars: No
  • Sheet Size: Letter (8-1/2" x 11")
  • Total Quantity: 1000 Medical Claim Forms

Additional Information

  • Country of Origin: US
  • UNSPSC Code: 14111810
  • UNSPSC Commodity: Personnel forms or personnel books
  • Green: No
  • Recycled Content: FALSE
  • Hazardous: No
  • Prop 65: No
  • MSDS URL: nan
  • Package Length: 11.00
  • Package Width: 8.50
  • Package Height: 1.00
  • Package Weight: 2.00
Product info last updated on February 14, 2026 5:55am UTC Category: Business Forms and Bookkeeping
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