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Edit Claim - General Tab

The Edit Claim window, General tab, has fields for prosthetics, orthodontic work, claim referrals, and claim note.

Crown, Bridge or Denture: For bridges, dentures, and partials, Missing Teeth must have been correctly entered in the Chart module. If Replacement is selected, a Prior Date is required. This information only shows on printed claims and is not sent electronically. To send this information electronically, enter on the Procedure Edit window (Prothesis Replacement, Original Date).

Place of Service: The service location. Defaults to the Place of Service on the last procedure in the claim (as set on the Procedures - Misc Tab). If Public Health is turned on, the default is based on the Site's default place of service.

  • Sent in dental 5010 e-claims only.
  • Changing place of service here will change the Place of Service on all procedures on the claim.
  • Usually set to Office. Exceptions: certain procedures to specific insurance carriers (e.g. Medicaid), sometimes when using Clinics.

Accident: Used to indicate that dental treatment was needed as the result of an accident.

  • Accident Related: The type of accident. Shows on printed claims in the following fields (depending on the value chosen): IsOccupational, IsNotOccupational, IsAutoAccident, IsNotAutoAccident, IsOtherAccident, IsNotOtherAccident, IsNotAccident, IsAccident, MedAccidentCode.
  • Accident Date: Shows on printed claims and e-claims. On printed claims, shows in the AccidentDate field.
  • Accident State: Shows on printed claims in the AccidentST field and on e-claims for auto accidents.

Ortho: Only used for Orthodontic claims.

  • Is for Ortho: Affects the IsOrtho and IsNotOrtho fields on printed claims. If the checkbox is marked, then Months Remaining is reported on e-claims (in Canada the ortho flag is sent electronically instead). Checked by default if claim includes an orthdontic procedure and the Ortho Setup for 'Mark claims as Ortho if they have ortho procedures' is checked.
  • Date of Placement: Shows on printed claims and dental e-claims. On printed claims, shows in the DateOrthoPlaced field. If 'Use the first ortho procedure date as Date of Placement' is checked in Ortho Setup, the date of the first orthodontic procedure on the claim auto-populates the field.
  • Months Total: Enter total months sent in 5010 e-claims.
  • Months Remaining: Shows on printed claims in the MonthsOrthoRemaining field if the value is greater than zero.

Claim Referral: Only enter a referring provider and referral number if it is required by your insurance carrier.

  • Referring Provider: Click select to attach a referring provider from an existing list, or add a new Referral. Click None to clear the field. Click Edit to enter notes or change information about the selected provider.
  • Referral Number: Provided by your insurance carrier. Do not put NPI numbers here; NPI numbers must be entered on the Edit Referral window. If an NPI number is missing, it will cause a claim rejection.

Note: For a Referring Provider on a claim, the Not Person checkbox must be unchecked and the Is Doctor checkbox checked. See Referral List for checkboxes. The information will not send otherwise.

Claim Note: Shows on printed claims and e-claims. This note is a claim level note. The claim note and attachment ID Number together are limited to 255 characters on a printed claim, or 80 characters for e-claims. If a procedure in the claim has a default claim note, it will automatically copy to this field when the claim is created. If multiple procedures have default claim notes, each note will added. Enter a procedure's default claim notes on the Procedure Code Edit window.

Note: There is also a procedure level note which only goes out on e-claims. There is no place on a printed claim form to put a procedure level note. Add procedure level note in the Procedure Edit window.

For more technical details, see E-Claim Complexities.


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