Edit Claim - General Tab

In the Claim - General tab are fields for prosthetics, orthodontic work, claim referrals, and claim note.

In the Claim Edit window, click the General tab.

Crown, Bridge or Denture: For bridges, dentures, and partials, Missing/Primary 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 Info window (Prosthesis 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 Procedure - Misc Tab). If Public Health is turned on in Show Features, the default is based on the site's default place of service (Site List).

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

Ortho: Only used for ortho claims.

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

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

Claim Note: A claim level note that shows on printed claims and e-claims. The claim note and attachment ID Number together are limited to 400 characters using the 5010 claim format, or 80 characters using the 4010. When printed using the ADA 2019 form, only approximately the first 253 characters will be visible. 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.

Note: There is also a procedure-level note, which only goes out on e-claims and medical HCFA 1500 Claim Form. There is no place on a printed claim ADA form to put a procedure-level note. Add procedure level note in the Procedure Info.