Back to Basics: Dental Claim Form
April 2024
We all know it is hard to keep up with the frequent changes to billing regulations and coding. Not to mention practice software updates and, at times, in-house staff turnover. But throw in the recent widespread clearinghouse migrations and it can be nearly overwhelming! So, let’s restart and refresh. This month, we are going back to the basics of a dental claim form submission.
What is a dental claim form?
A dental claim form is used to request reimbursement by insurance plans for dental services rendered. It serves as a detailed record of the treatments provided and includes general information on: patient, subscriber, insurance, provider, treatment, billing entity and location. The current version is 2024 ADA Dental Claim Form © (For more information, visit https://www.ada.org/publications/cdt/ada-dental-claim-form)
Paper vs. Electronic
It’s easy to think that the “print preview” version of your dental claim form is what is sent electronically to your clearinghouse. However, electronic claims have their own dedicated format called the Electronic Dental Claim (837D). It is comprised of data ‘loops’ and while it is similar to the print format, it is not identical.
Important Note: Many practice management software vendors are still rolling out updates to include the newest 2024 ADA Dental Claim Form. Contact your software representative for more information. Plus, the latest form changes have not yet impacted the electronic Dental Claim (837D) and to utilize the additional fields a paper form must be used.
What information is included on a dental claim?
All dental claim forms include general information on: patient, subscriber, insurance, provider, treatment rendered, billing entity and location. There are currently 58 fields on the current ADA Dental Claim Form. To accurately complete a claim form, it is imperative that you understand what information belongs in each field and, moreover, how your software populates it. Often there are software settings that allow you to modify or select what software fields populate in what areas of the claim form (sometimes differing for print or electronic as mentioned above).
Examples by Software
Let’s say you want to populate field
“2. Predetermination/Preauthorization Number”
on the printed ADA Dental Claim Form (or Loop 2300
and 2400 in 837D electronic format). Click tiles below for each software:
How do you know what information is required?
Requirements for services rendered vary by procedure code, clinical diagnosis, and insurance payer guidelines. It is important to stay up-to-date with annual ICD-10, CDT, and CPT coding and form updates. It is also important to stay current with all of your in-network payer specific guidelines. Sending all required information with your initial claim submission helps minimize needless rejections and denials which can delay the timely filing of your claim.
What if you need help, advice, or staff training?
Dental Billing & Consulting Professionals is always happy and available to be a resource to you. Our consulting and billing services are customized to your specific needs and goals. Call or text us at (860) 435-7344 any time to learn how we can support you in optimizing your practice.