https://www.staples-3p.com/s7/is/image/Staples/30211E02-A935-406B-A6832AFD0B88E088_sc7
ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)
$133.69
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
  • 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
MADE IN AMERICA

ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)

Item #: 24602226Model #: 20241
Final price is $133.69
 

Free Returns

Online. In store. Always free.

Learn More

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Over 30
  • 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
    • ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
    Specifications table
    Attribute nameAttribute value
    Length in Inches 11
    Form Size
    8-1/2" x 11"
    Medical Form Pack Size 2500
    Number of Parts 1
    Medical Form Type Dental Claims
    Acid Free
    Acid Free
    Width in Inches
    8.5
    Print Type Laser
    True Color
    White

    Compare similar items

    Product specifications table
    Attributes ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241) ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411) ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5) ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
    Your product
    Price is $133.69
    Reviews
    No reviews yet
    No reviews yet
    No reviews yet
    No reviews yet
    No reviews yet
    Delivery Information
    Free delivery by Tue, Apr 14
    Free delivery by Tue, Apr 14
    Free delivery by Tue, Apr 14
    Delivery by Thu, Apr 16
    Delivery by Tue, Apr 14
    Available in my store
    No
    No
    No
    No
    No
    Width in Inches
    8.5
    8.5
    8.5
    8.5
    8.5
    Length in Inches
    11
    11
    11
    11
    11
    Form Size
    8-1 / 2" x 11"
    8-1 / 2" x 11"
    8-1 / 2" x 11"
    Data not available
    8-1 / 2" X 11"
    Medical Form Pack Size
    2500
    1000
    500
    500
    100
    Medical Form Type
    Dental Claims
    Dental Claims
    Dental Claims
    Health Insurance Claims
    Dental Claims
    True Color
    White
    White
    White
    Data not available
    White
    Print Type
    Laser
    Laser
    Laser
    Laser
    Laser
    Number of Parts
    1
    1
    1
    Data not available
    1
    Acid Free
    Acid Free
    Acid Free
    Acid Free
    Acid Free
    Acid Free
    Price Per Unit
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Add To Cart
    Add To Cart
    Add To Cart
    Add To Cart