ADA Dental Insurance Forms by PMIC
The latest format! ADA dental insurance claim form with required National Provider Identifier (NPI).
Read Full Description
- Item#: ADA896
- Edition: New Format
- Format: Continuous Feed (Pin Fed)
- ISBN#: See Below
- Availability: In Stock
- Product Notes:
- Ships standard ground only. Usually ships in 48 hours.
New American Dental Association Claim Form
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Choose the Correct Forms
- Identify the type of printer you use with the pictures below.
- Select the correct form: CMS-1500, UB-04, or Dental.
- For continuous form printers (dot matrix), select the number of parts.
Continuous Feed Printer
If you use a dot matrix printer (AKA pin or tractor feed) as pictured, choose continuous forms:
- #89110: CMS-1500 1-Part Continuous
- #89115: CMS-1500 2-Part Continuous
- #89120: CMS-1500 3-Part Continuous
- #89130: CMS-1500 1-Part Continuous w/ Mailing Label
- #89135: CMS-1500 2-Part Continuous w/ Mailing Label
- #89201: UB-04 1-Part Continuous
- #89202: UB-04 2-Part Continuous
- #89203: UB-04 3-Part Continuous
- #89634: Dental Form 1-Part Continuous
- #89636: Dental Form 2-Part Continuous
Sheet Fed Printer
If you use a sheet fed printer as pictured, choose 1 Part forms:
- #89105: CMS-1500 Laser Sheets
- #89208: UB-04 Laser Sheets
- #89535: Dental Form Laser Sheets
Laser Printer
If you use a laser / ink jet printer as pictured, choose 1 Part forms:
- #89105: CMS-1500 Laser Sheets
- #89208: UB-04 Laser Sheets
- #89535: Dental Form Laser Sheets
These ADA claim forms are the "new" format - required by May 23, 2007.
Starting May 23, 2007 providers will be required to have a NPI when transmitting electronic claims or other electronic transactions governed by HIPAA.
The ADA Dental Claim Form has been updated and now includes a field for the National Provider Identifier. Starting May 23, 2007 providers will be required to have a NPI when transmitting electronic claims or other electronic transactions governed by HIPAA. Many payers will be accepting the new claim form as of January 1, 2007.
We stock three different formats of the dental insurance claim form approved by the American Dental Association (ADA).
What is the difference in the available formats? "Computer" forms have tear off sides and produce a duplicate copy. "Laser Sheets" are used with a desk jet or ink jet printer.
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