With each new year comes changes in dental billing. Whether it’s updates to software, dental codes, or insurance plans, the field is constantly evolving. One item updated for 2024 is the ADA claim form. The form is required for all dental claims and hasn’t been updated since 2019. In the following, we will discuss the changes that created the 2024 ADA claim form.
Why is the ADA claim form changing?
According to the ADA, the 2024 claim form “provides new spaces for reporting data that can expedite timely and accurate claim reimbursement.“ To do this, three changes were made to the form. This should improve the billing process and allow claims to be processed faster.
Update #1 – Locum Tenens dentists
Locum Tenens dentists are those who temporarily replace other dentists. When an owner or associate dentist is out due to illness or vacation, a temporary replacement is often brought onsite to cover their absence. Because they are not regular members of the office staff, it can be difficult to bill insurance claims under them, especially if they’re not credentialed with the office.
The 2024 ADA Claim form now includes box 53a to clarify this. Box 53a includes the question “Locum Tenens Treating Dentist?” and a checkbox. When a Locum Tenens dentist is used, check the box. This will then notify the insurance company that the dentist is temporarily filling in. It will explain why they are not credentialed with the office. Hopefully, it will also alleviate credentialing issues. As insurance company guidelines supersede ADA guidelines, this remains to be seen.
Update #2 – Scaling & Root Planing Dates
Certain dental procedures, like perio maintenance, require the patient’s perio history to be paid. In the past, there was no specific place for this on the claim form. The dental biller had to manually add the date to the comment section or include it as an attachment. With the rise of electronic claim submission, this step was often skipped causing carriers to reject claims due to insufficient information.
Box 39a has been added to the ADA claim form to include this information. Here you will find the phrase, “Date last SRP”, and a space to add the date. This allows the perio history to be easily added to the claim, both manually and electronically. With this specific area designated for SRP history, perio claims can now be submitted uniformly and processed quickly.
Update #3 – Payer ID
The payer ID is used to identify dental insurance carriers when submitting electronic claims. This ensures the claim is submitted to the correct carrier when sent electronically. Previously, there was no area for it on the ADA claim form. This required billers to add it to an undesignated area manually. More often, it wasn’t included at all.
Box 3a has been added to the 2024 ADA claim form to provide a designated area for the payer ID. It includes the phrase “Payer ID” with a space to add the identification. This will allow for uniform billing and will help ensure claims are submitted to the correct payors.
When does the 2024 ADA claim form go into effect?
The 2024 ADA claim form is available for use as of January 1, 2024. Not all insurance carriers will require its use immediately. Though there may be time to phase out the 2019 claim form, it’s best to adopt the 2024 version as soon as possible. Eventually, it will be the only option and it’s best to start using it now to avoid any unnecessary claim rejections.
The new ADA claim form aims to help improve the dental billing process. Although it will help expedite processing, dental claims submission is still a lengthy process. If you are struggling with processing claims, consider partnering with eAssist. Our Success Consultants are familiar with all ADA updates and will process your claims quickly and correctly. To learn more, complete the field below.
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