The ADA maintains the standardized claim form used for insurance billing. While the ADA updates the codes annually, the claim format is only updated occasionally. The 2024 paper version of the Standard ADA Printed Claim Form includes four new fields:
· Box 3a. Payer ID – For third-party payers.
· Box 11a. Other Payer ID – For other supplemental coverage.
· Box 39a. Date Last SRP – (Not included in the electronic claim format)
· Box 53a. Locum Tenens Treating Dentist? – (Not included in the electronic claim format)
Notes:
· These changes apply to the printed version of the form only and have no impact on electronic claims. The ADA encourages you to continue submitting paper claims only when documentation for Locum Tenens or Last SRP is needed.
· For a complete explanation of these new fields, please click the following link: 2024 ADA Dental Claim Form Completion Instructions.
