A meeting is scheduled for Friday, June 5 to go over suggestions for revisions to the ADA claim form. The following is a summary of the proposed suggestions pertinent to state Medicaid agencies and their status. In order to understand what the revisions are related to, download the claim form.

1) Add quantity or units field. There were comments and support but I am not sure of the priority on this item. It may need further discussion.

2) Record of services provided--enable reporting of primary paid amount on COB claims. There was no apparent consensus.

3) Place of Service field to include the place of service codes maintained by CMS. There were comments but no consensus on the addition. Commercial payers did not know the list of POS codes maintained by CMS and wanted further explanation.

4) Add field for Diagnosis. There was consensus to accept this one.

5) Add field for Modifiers. There was no consensus and from the votes it appears that it will be declined. Until the modifiers are defined by ADA, there is no support by the commercial payers.

6) Add field for an emergency indicator box. There was apparent consensus to accept but voted low priority.

7) Add box for pregnant women only. This is not an 837 data element, so it was declined.

8) Change title to Billing Provider or Dental Entity from Billing Dentist. The apparent consensus is to accept.

9) Change title to Treating provider or Authorized signature and treatment from Treating Dentist. The apparent consensus is to accept.

To comment on these proposed changes, contact Chris Farrell.