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Specification
Brand : NextDayLabels
BulletPoint1 : Comprehensive Form: This ADA American Dental Association Dental Claim Form is a comprehensive document for submitting dental claims and treatment information. Pack of 500 Sheets
BulletPoint2 : Detailed Sections: The form includes sections for patient information, policyholder/subscriber details, dental benefit plan information, and a record of services provided.
BulletPoint3 : Coding Support: It allows for entering diagnostic codes, treatment codes, and other relevant coding for proper claim processing.
BulletPoint4 : Authorization Segment: There is a dedicated section for obtaining authorizations and signatures from the patient or policyholder.
BulletPoint5 : Dentist Information: The form provides fields to enter the treating dentist's name, address, license number, and other relevant details, Made in the USA by Next Day Labels TM
Color : White
ExternallyAssignedProductIdentifier1 : 0790757378155
ExternallyAssignedProductIdentifier2 : 790757378155
GpsrSafetyAttestation : 1
ItemDisplayDimensions_Height : 4.75 inches
ItemName : NextDayLabels - ADA Dental Claim Insurance Claim Forms, 8-1/2" X 11" Letter Size for Laser or Ink Jet Printers (Pack of 500 Sheets)
ItemPackageDimensions_Height : 1.5 inches
ItemPackageDimensions_Length : 11 inches
ItemPackageDimensions_Width : 8.5 inches
ItemPackageQuantity : 1
ItemTypeKeyword : business-claim-forms
Manufacturer : NextDayLabels
Material : Paper
ModelNumber : NDL-ADA forms
NumberOfItems : 1
PaperSize : 8.5-x-11-inch
PartNumber : NDL-ADA forms
ProductDescription : This American Dental Association (ADA) dental claim form is an essential document for dental professionals and patients alike. It serves as a standardized template for submitting claims to insurance companies for reimbursement of dental services rendered. The form captures crucial information such as patient details, dental benefit plan information, services provided, diagnosis codes, treatment details, and billing information. With designated sections for authorizations and ancillary claim/treatment information, this comprehensive form streamlines the claims process, ensuring accurate and efficient communication between dental providers and insurance carriers. Measuring 8.5 x 11 inches, this form can be easily printed and filled out by hand or electronically, facilitating seamless record-keeping and claims submission within the dental industry. Pack contains 500 Sheets, Made in the USA by Next Day Labels TM
ProductSiteLaunchDate : 2024-11-13T21:33:17.021Z
Size : Pack of 500 Sheets
Style : Pack of 500 Forms
SupplierDeclaredDgHzRegulation : not_applicable
SupplierDeclaredHasProductIdentifierExemption : 1
UnitCount : 300
UnspscCode : 55121600
WarrantyDescription : 1