Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-161 - UNIFORM INSURANCE CLAIM FORMS AND PRIOR AUTHORIZATION FORMS
Section 69O-161.005 - Use of Dental Claim Form
Universal Citation: FL Admin Code R 69O-161.005
Current through Reg. 50, No. 187; September 24, 2024
All companies writing dental insurance shall accept Form HCFA 1500 (12/90) and the American Dental Association Dental Claim Form (Form J510, J511, or J512) (1/94). For informational purposes only, the Florida Medicaid dental program shall accept the Non-Institutional Dentist Claim Form (Form 111) (1/89) and Form HCFA 1500. All said forms are hereby incorporated and made part of this rule chapter by reference.
Rulemaking Authority 624.308(1), 627.647 FS. Law Implemented 624.307(1), 627.647 FS.
New 6-8-94, Amended 12-5-95, Formerly 4-161.005.
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