MedicaidAdministrativeHigh impact
Newsletter Vol. 20, No. 05
New Jersey Medicaid·NJ · Dentistry·Provider Notice
Effective date
Apr 1, 2010
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is transitioning to require the 2006 ADA dental claim form for all paper claim submissions. The old MC-10 Dental Claim form will be phased out completely by July 1, 2010, with both forms accepted during a transition period through June 30, 2010.
Action Required
By July 1, 2010: Dental practices must transition completely to using the 2006 ADA dental claim form for all New Jersey Medicaid paper claim submissions. Stop using MC-10 Dental Claim forms after June 30, 2010. Download and review the revised Fiscal Agent Billing Supplement from www.njmmis.com for specific completion requirements. Update billing workflows to use ADA forms while continuing to submit separate prior authorization forms (MC-10) when required. Claims submitted on old forms after July 1, 2010 will not be accepted.