TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > 2006 American Dental Association (ADA) Dental Claim Filing Instructions > ADA Dental Claim Form (Paper) Billing


6.7.2 ADA Dental Claim Form (Paper) Billing

All participating THSteps dental providers are required to submit a 2006 ADA Dental claim form for paper claim submissions to Texas Medicaid. These forms may be obtained by contacting the ADA at 1-800-947-4746.

Claims must contain the billing provider's complete name, address and a provider identifier. Claims without a provider name, address, and provider identifier cannot be processed.

Texas Medicaid & Healthcare Partnership
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