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ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)
$62.99
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ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)~#|#~4A9BEC59-372C-4BA2-98230C384214A03F_sc7
ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)~#|#~C2AA26C1-92F7-416C-ADD56F084E1C3A72_sc7
Highlights
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  • Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
  • Forms provide a common format for reporting dental services to a patient's dental benefit plan
  • ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
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ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)

Item #: 24602227Model #: 202411
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Only $9.89 Staples Smooth Paper Clips, 1000/pack. Add to cart.
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ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)~#|#~C2AA26C1-92F7-416C-ADD56F084E1C3A72_sc7ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)~#|#~4A9BEC59-372C-4BA2-98230C384214A03F_sc7
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    • Details

    About this product

    ComplyRight Dental Claim Forms allow healthcare providers to bill a patient's insurance company for reimbursement of dental claims.

    Starting January 1, 2024, providers and dental industry partners will see crucial updates designed to streamline dental claims processing. 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. Forms adhere to strict printing standards that govern the layout, paper and ink. 100% compliant to meet ADA guidelines. The following materials are prepared by ADA Practice Institute staff with contributions from the ADA Council on Dental Benefit Programs and other internal and external knowledge experts. The 2024 version provides new spaces for reporting data that can expedite timely and accurate claim reimbursement. It is 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.

    • Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
    • Forms provide a common format for reporting dental services to a patient's dental benefit plan
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    Specifications
    Specifications table
    Attribute nameAttribute value
    Length in Inches 11
    Form Size
    		8-1/2" x 11"
    Number of Parts 1
    Medical Form Type Dental Claims
    Acid Free
    		Acid Free
    Width in Inches
    		8.5
    Print Type Laser
    True Color
    		White
    Medical Form Pack Size 1000
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    ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)
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    Your product
    ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)
    Price is $62.99
    TFP UB-04 CMS-1450 Health Insurance Claims, 2500/Carton (UB04LC)~#|#~s1172744_sc7
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    Reviews
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    3.3
    3
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    4.8
    19
    4
    1
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    1
    1
    4.6
    5
    4.8
    57
    Delivery Information
    Free delivery by Fri, May 02
    Free delivery by Fri, May 02
    Free delivery by Fri, May 02
    Free delivery by Fri, May 02
    Delivery by Fri, May 02
    Delivery by Tue, May 06
    Next-Day Delivery by tomorrow
    Free delivery by Mon, May 05
    Free delivery by Mon, May 05
    Free delivery by Mon, May 05
    Free delivery by Mon, May 05
    Free delivery by Mon, May 05
    Free delivery by Fri, May 02
    Available in my store
    No
    No
    No
    No
    No
    No
    No
    No
    No
    No
    No
    No
    No
    Medical Form Type
    Dental Claims
    Health Insurance Claims
    Dental Claims
    Dental Claims
    Dental Claims
    Health Insurance Claims
    Health Insurance Claims
    Medical Records Folders
    Privacy Practice
    Data not available
    Medical Records Folders
    Medical Records Folders
    Health Insurance Claims
    Width in Inches
    8.5
    Data not available
    8.5
    8.5
    8.5
    8.5
    8.5
    9.375
    8.5
    9.5
    9
    11.5
    8.5
    Medical Form Pack Size
    1000
    2500
    500
    2500
    100
    500
    250
    25
    100
    Data not available
    25
    25
    2500
    Length in Inches
    11
    Data not available
    11
    11
    11
    11
    11
    11.75
    11
    11.75
    11
    Data not available
    11
    Form Size
    8-1 / 2" x 11"
    Data not available
    8-1 / 2" x 11"
    8-1 / 2" x 11"
    8-1 / 2" X 11"
    Data not available
    8 1 / 2" x 11"
    9.375" x 11.75"
    8 1 / 2" x 11"
    11.75" x 9.5"
    9" x 11"
    Data not available
    8 1 / 2" x 11"
    True Color
    White
    White / Red
    White
    White
    White
    Data not available
    White
    Data not available
    White
    Manila
    Data not available
    White / Blue
    White / Red
    Print Type
    Laser
    Laser
    Laser
    Laser
    Laser
    Laser
    Laser
    Data not available
    Data not available
    Data not available
    Data not available
    Inkjet / Laser
    Laser
    Number of Parts
    1
    1
    1
    1
    1
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    1
    1
    Acid Free
    Acid Free
    Data not available
    Acid Free
    Acid Free
    Acid Free
    Acid Free
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Acid Free
    Price Per Unit
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    $4.42 / File Folder
    Data not available
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