ADA Opens Prior Authorization and Predetermination Standard for Comment

Edited by Orthotown staff

The ADA Standards Program has opened a proposed standard for electronic predetermination and prior authorization to public review, along with a companion proposal covering dental explanations of benefits. Comments on both are due Aug. 21.

Proposed ANSI/ADA Standard No. 1120-5, “Dentistry – Data Content Standard – Part 5: Prior Authorization and Predetermination,” outlines a uniform approach to electronic predetermination and prior authorization. It references X12 278 TR3 prior authorization formats and HL7 FHIR R4.

ADA Standards Working Group 11.10 developed the proposal in collaboration with Working Group 11.15.

The companion proposal, No. 1120-4, “Dentistry – Data Content Standard: Dental Explanation of Benefits,” specifies the elements required to generate a comprehensive dental EOB. It also identifies the information that should pass between providers and payers so that adjudicated claim details are exchanged transparently. Working Group 11.15 developed that proposal with 11.10.

Both belong to the ADA’s 1120 series of dental data content standards. Comments on either go to standards@ada.org.

The two data content proposals remain drafts. The public review period is the stage at which practices, payers, and software developers can submit comment before the standards are finalized.

Sources:
American Dental Association, Standards Available for Public Review: ada.org/resources/practice/dental-standards/aip-review
ADA News, “Proposed ADA standard specifies requirements for comprehensive, consistent dental EOBs,” July 24, 2026: adanews.ada.org/2026/july/proposed-ada-standard-dental-eobs