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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.7 2006 American Dental Association (ADA) Dental Claim Filing Instructions : 6.7.2 ADA Dental Claim Form (Paper) Billing

6.7.2
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
CPT only copyright 2011 American Medical Association. All rights reserved.