Addresses on Claims

In Practice Setup and the Clinic List, there are three options for addresses:

Below is an explanation of the logic that determines which addresses are sent in e-claims and printed claims.

E-Claims in 5010 Format

A billing address is required in e-claims and a pay to address is optional.

Open Dental determines an address using the logic below in this order.

No Clinics Clinic attached to the claim
Billing Address (version 15.3 and greater)
  1. Practice Billing Address if Use on Claims is checked
  2. Practice Physical Treating Address
  1. Clinic Billing Address if Use on Claims is checked
  2. Practice Billing Address if Use on Claims is checked
  3. Clinic Physical Treating Address
Pay To Address
  1. Practice Pay To Address if not blank
  1. Clinic Pay To Address if not blank
  2. Practice Pay To Address if not blank
Billing Address (version 15.2 and earlier)
  1. Practice Billing Address if Use on Claims is checked
  2. Practice Address
  1. Practice Billing Address if Use on Claims is checked
  2. Clinic Address

Service Facility address (place of service address): Sent in loop 2310C for 5010 dental e-claims when the following criteria is met.

Note:
  • 5010 e-claims require a 9 digit zip code for practice address. Visit https://tools.usps.com/go/ZipLookupAction_input.
  • Emdeon: If the Pay-To address is sent on an e-claim to Emdeon, then Emdeon will refer to the pay-to address as the billing address on a claim detail printout (since it does not need to be a physical address). It will refer to what is normally considered the billing address as the rendering address since it must be a physical address.
  • Many carriers began rejecting PO Boxes in the Billing address in 1/1/12. This applies to both 4010 and 5010 formats.

Printed Claims

On a printed claim form there is usually an address for the billing provider and the treating provider. The field used for the billing provider address is usually PayToDentistsAddress. The field used as the treating provider is usually TreatingDentistAddress. The field can be verified by looking at the claim form.

Open Dental determines which address populates these fields using the logic below in this order.

Fields No Clinics Clinic attached to the claim
PayToDentistAddress
  1. Practice Pay To Address if not blank
  2. Practice Billing Address if Use on Claims is checked
  3. Practice Physical Treating Address
  1. Clinic Pay To Address if not blank
  2. Practice Pay To Address if not blank
  3. Clinic Billing Address if Use on Claims is checked
  4. Practice Billing Address if Use on Claims is checked
  5. Clinic Physical Treating Address
TreatingDentistAddress Practice Physical Treating Address Clinic Physical Treating Address