https://www.staples-3p.com/s7/is/image/Staples/8C5CF2B1-C564-4834-B70E58035F19DEAC_sc7
ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)
$42.49
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, 500 Forms/Pack (20241500)

Item #: 24602228Model #: 20241500
Final price is $42.49

Free Returns

Online. In store. Always free.

Learn More

Only $6.99 Tru red 8.5 x 11 copy paper, 500 per sheet. add to cart.
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

Consider this similar product

ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211)
Price is $149.69
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
Customers bought together
ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)~#|#~ADC4927C-2F2B-490A-BFBD9CBB33F23DF2_sc7ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)~#|#~8C5CF2B1-C564-4834-B70E58035F19DEAC_sc7
ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) is Your Product
Price is $42.49
Staples 30% Recycled File Folders, 1/3-Cut Tab, Letter Size, Manila, 100/Box (ST56675)~#|#~FD6708EB-0D9C-4710-B97EE04BFBA39232_sc7Staples 30% Recycled File Folders, 1/3-Cut Tab, Letter Size, Manila, 100/Box (ST56675)~#|#~5C934D7B-B3EC-4A1C-AF00C0533240423D_sc7
Price is $16.99, Regular price was $20.59, You save 17%
Tape Logic Inventory Circle Labels, 3/4", Red, 500/Roll (DL610A)~#|#~sp127290182_sc7Tape Logic Inventory Circle Labels, 3/4", Red, 500/Roll (DL610A)~#|#~m004078547_sc7
Price is $33.89
Price for all 3
$93.37
  • 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

    Frequently bought together

    Compare similar items

    Product specifications table
    Attributes ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500) ComplyRight Confidential Employee Medical Records Folder, Pack of 25 (A2211) ComplyRight Employee Warning Notice, Pack of 50 (A2311) ComplyRight Orthodontic Case Analysis File, 9.5" x 11.75", 25 Folders/Pack (A1048) ComplyRight Notice of Privacy Practice, 100/Pack (A1349)
    Your product
    Price is $42.49
    Reviews
    No reviews yet
    No reviews yet
    No reviews yet
    No reviews yet
    Delivery Information
    Free delivery by Mon, Jun 30
    Free delivery by Tue, Jul 01
    Free delivery by Tue, Jul 01
    Free delivery by Tue, Jul 01
    Free delivery by Tue, Jul 01
    Available in my store
    No
    No
    No
    No
    No
    Width in Inches
    8.5
    9.375
    8.5
    11.75
    8.5
    Length in Inches
    11
    11.75
    11
    9.5
    11
    Form Size
    8-1 / 2" x 11"
    9.375" x 11.75"
    8 1 / 2" x 11"
    9.5" x 11.75"
    8 1 / 2" x 11"
    Medical Form Pack Size
    500
    25
    Data not available
    Data not available
    100
    Medical Form Type
    Dental Claims
    Medical Records Folders
    Data not available
    Data not available
    Privacy Practice
    True Color
    White
    Data not available
    White
    Beige
    White
    Print Type
    Laser
    Data not available
    Data not available
    Data not available
    Data not available
    Price Per Unit
    Data not available
    Data not available
    Data not available
    Data not available
    Data not available
    Number of Parts
    1
    Data not available
    Data not available
    Data not available
    Data not available
    Add To Cart
    Add To Cart
    Add To Cart
    Add To Cart