CSHCN 2009 > Dental > Claims Information

14.3 Claims Information

Dental services must be submitted to TMHP in an approved electronic format or on the ADA Dental Claim Form (Copyright 2006, American Dental Association). Providers can obtain copies of this form by contacting the ADA at 1-800-947-4746 or ordering online from the ADA website at www.ada.org. TMHP does not supply the forms. Any paper dental claim submitted using any other version of the dental claim form is not processed and is returned to the submitter.

When completing an ADA Dental Claim Form, all required information must be included on the claim, as information is not keyed from attachments. Superbills, or itemized statements, are not accepted as claim supplements.

Providers billing electronically must submit dental claims in American National Standards Institute (ANSI) ASC X12 837D format. Specifications are available to providers developing in-house systems, software developers, and vendors. Because each software package is different, field locations may vary. Providers should contact the software developer or vendor for information about their software. Providers or software vendors may direct questions about development requirements to the TMHP EDI Help Desk at 1-888-863-3638.

Claims must contain the billing provider's full name, address, and provider identifier. The billing provider's full name and address must be entered in Block 48 of the ADA Dental Claim Form, and the nine-digit provider identifier must be entered in Block 49. A claim without a provider name, address, and provider identifier cannot be processed.

Refer to: Chapter 36, "TMHP Electronic Data Interchange (EDI)" on page 36-1 for information on electronic claims submissions.

Chapter 5, "Claims Filing, Third-Party Resources, and Reimbursement" on page 5-1 for general information about claims filing.

Section 5.7.1.13, "Instructions for Completing the ADA Dental Claim Form" for instructions on completing paper claims. Blocks that are not referenced are not required for processing and may be left blank.