11 NCAC 12 .1504             REQUIREMENTS FOR USE OF THE CURRENT ADA DENTAL CLAIM FORM

(a)  Effective January 1, 1995, with implementation to be complete no later than April 1, 1995, Dentists shall use the current ADA Dental Claim Form and instructions for all manual claims filing with payors.

(1)           The provider tax I.D. number shall be located in form locator 18.

(2)           The ethnic origin code shall be located in form locator 31 using Code X1‑X5 (see definitions as defined in the State Uniform Billing Manual), to translate the ethnic origin codes, and shall be the first entry on the first line of that form locator, and it shall be followed by the symbol "/".

(b)  A Uniform Billing Manual, similar to the concept used by the SUBC for the HCFA Form 1450 (UB92), shall be developed to set standards for the current ADA Dental Claim Form by August 1, 1995.  The North Carolina Dental Society may develop and recommend a Uniform Billing Manual to the Commissioner on or before August 1, 1995.

 

History Note:        Authority G.S. 58‑2‑40; 58‑3‑171;

Eff. October 1, 1994;

Amended Eff. February 1, 1995.