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ADA: Use 2012 version of dental claim form

February 06, 2017

By Kelly Soderlund

Every dentist should be using the 2012 version of the ADA Dental Claim Form to avoid delayed payment and claims processing problems, according to the Association.

The ADA and the National Association of Dental Plans are pushing their members to only use the 2012 form and not any other version in an effort to speed up claim processing for both sides.

"There are some offices with older versions of the ADA form," said Dr. Ron Riggins, chair of the ADA Council on Dental Benefit Programs. "But they are obsolete and difficult to process. National Association of Dental Plans members tell us that when they receive an old form — 2006 or earlier — special manual intervention is needed, which affects timely and efficient adjudication and reimbursement."

Many dentists are submitting claims electronically but there are a good amount who still use the paper form exclusively or depending on the circumstance. When a paper form is submitted, it's scanned to convert it to an electronic version. Many times, if a dentist uses an outdated form, the computer program will flag it, even for something miniscule, and indicate it needs a manual review, said Evelyn Ireland, executive director of the National Association of Dental Plans.  

Some dentists may still use an outdated form because they have a surplus of hard copies they want to get rid of. Others may not appreciate that the differences between the older forms and the current version are vast enough to make the change.

Dental payers have continued to accept older versions of the form in order to maintain a good positive relationship, but the National Association of Dental Plans is encouraging them to enforce the 2012 version.

"We've just kind of let the issue linger but it causes delays in reimbursement and slows down the process," Ms. Ireland said. "Moving to the new form just reduces unnecessary administrative costs and delays."

The Council on Dental Benefit Programs developed the current version of the ADA form in consultation with representatives from the dental benefit plan community and industry groups that maintain the HIPAA standard dental claim transaction. By ADA policy and the 2012 version of the ADA's dental claim form includes the same data as seen in the HIPAA standard electronic dental claim.

The ADA Dental Claim Form (J430D) can be ordered in several formats from or 1-800-947-4746. To save 15 percent on this and all ADA Catalog products, use promo code 17114 by March 31.