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American Dental Association (ADA) Dental Claim Form

Missouri Medicaid (MO HealthNet)·MO · Dentistry·Provider Notice
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

When submitting paper ADA Dental Claim forms, dental providers must complete Field 23 with the participant's MO HealthNet number exactly as shown on their ID card. Claims will be denied if the field is left blank or contains anything other than the participant's DCN.

Action Required

Action needed
Immediately: Dental billing staff must ensure Field 23 on all paper ADA Dental Claim forms contains the participant's MO HealthNet number exactly as shown on the participant's ID card. Verify DCN accuracy before submission. Claims with blank or incorrect Field 23 entries will be denied.

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