ARM 6.6.5511. REQUIREMENTS FOR USE OF J512 FORM

(1) Dentists shall use the J512 form and instructions provided by the American dental association CDT-1 for use of the J512 form for filing claims with issuers for professional services. Dentists that bill patients directly shall provide a properly completed J512 form in addition to any other form used to bill the patient when requested by the patient. (2) Issuers may not require a dentist to use any code other than the CDT-1 codes for the initial filing of claims for dental care services, unless the use of supplemental codes are defined and permitted in a written contract between the issuer and dentist. (3) Hospitals may use the HCFA Form 1500 to supplement a HCFA Form 1450 (UB-92) if necessary in billing patients or their representatives of filing claims with issuers for outpatient services.