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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.7 2012 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 2012 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 2014 American Medical Association. All rights reserved.