This article walks you through each field of the ADA 2012 and 2019 Forms, and how each field is populated.
Click the link below for the ADA 2024 form:
If you’re looking for the CMS Form at a Glance article, check this article here:
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MacPractice will also put an X in the Predetermination/Preauthorization box when a Predetermination is printed for the patient. A predetermination is printed from the Treatment Plan in the Ledger screen. Select the treatment charges and then from the Print pop-up menu select the Print Predetermination.
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ADA Box 2 - Predetermination/Preauthorization
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The Diagnosis Codes will generate a letter corresponding to one of the four codes (A-D) that will appear in Box in Box 29a.
ADA Box 35 - Remarks
This box populates from the Notes tab in the charge window.
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Information is pulled from Box 39 Number of Enclosures fields for Radiograph(s), Oral Image(s) and Model(s), found under the Claims tab of the Incident.
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Note: This Claims view is visible on MacPractice DDS by default. If you are on MacPractice MD, DC, or 20/20, you may need to check "Display both CMS and ADA Claim view" in Preferences > Ledger > Incident Tab. |
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This information can only be changed or updated by MacPractice.
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Note: If there is an alternate name entered into a field in the Provider's User reference, located in Users > Providers Tab > "Name on Line 1 of ADA Box 48 (optional)", that information will pull into Line 1 instead of the Office Name. |
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