You can change the information that is specific to a patient and a specific medical pre-treatment estimate. The standard information appears on the pre-treatment estimate unless it has been changed.
Notes:
Changing the standard medical pre-treatment estimate information from the pre-treatment estimate window affects the medical pre-treatment estimate and any associated primary or secondary medical pre-treatment estimate.
Changing the standard medical pre-treatment estimate information requires the "Insurance Claims, Edit" security right.
To change standard medical pre-treatment estimate information
In the pre-treatment estimate window, double-click the Claim Information block.
Note: The Claim Information block displays "Standard" unless the information has been changed; in which case, it displays "Non-Standard."
If applicable, do one of the following:
If the Password - Insurance Claims, Edit dialog box appears, user verification has been assigned to the "Insurance Claims, Edit" task. Do one of the following:
If your user account has been granted the "Insurance Claims, Edit" security right, enter your credentials in the User ID and Password boxes, and then click OK.
If your user account has not been granted the "Insurance Claims, Edit" security right, have a user with permission temporarily override this restriction so you can change standard pre-treatment estimate information this one time. The overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
If a message appears, informing you that you do not have rights to this operation, your user account has not been granted the "Insurance Claims, Edit" security right. To have a user with permission temporarily override this restriction so you can change standard pre-treatment estimate information this one time, do the following:
On the message, click Yes.
In the Password - Insurance Claims, Edit dialog box, the overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
The Medical Insurance Claim Information dialog box appears.
Change any of the following options as needed:
Type of Claim - The type of pre-treatment estimate being submitted. Select one of the following options: MEDICARE, MEDICAID, CHAMPUS, CHAMPVA, GROUP HEALTH PLAN, FECA BLK LUNG, or OTHER.
Student Status - To specify that a patient is enrolled in school (college, university, and so forth), select one of the following options: None, Part-Time, or Full-Time. If the Part-Time or Full-Time option is selected, enter the school and city in the School - City box.
Referring Physician - To specify a referring physician, do the following:
Click the Referred
search button 
.
The Select Referred By dialog box appears.
If
the list is long, to filter it by name, in the Enter
Name box, enter all or part of the referral source name, and then
click the search button .
In the list, select the correct referral source.
Click OK.
With a referring physician selected, specify IDs for that provider as needed:
First ID - Select an ID type from the ID Number Type list, and enter an ID (up to 29 characters in length) in the ID Number box.
Second ID - Select an ID type from the 2nd ID Number Type list, and enter an ID (up to 29 characters in length) in the 2nd ID Number box.
Notes:
For a referring physician, only one ID is required: either the NPI or the UPIN. However, if you want to include both IDs, the ID Number Type must be NPI, and the 2nd ID Number Type must be UPIN.
By default, Dentrix Enterprise uses the referring physician's information from a referral that is associated with a procedure on the pre-treatment estimate.
You can enter a referring provider’s ID for a specific insurance plan by setting up provider IDs for a rendering, billing, or pay-to provider.
Is Patient's Condition Related To?:
Employment? - If the treatment for this pre-treatment estimate became necessary due to a work-related injury or illness, select this checkbox.
Auto Accident? - If the treatment for this pre-treatment estimate became necessary due to an automobile accident, select this checkbox, and then enter the 2-letter abbreviation of the state where the accident occurred in the corresponding State box.
Other Accident? - If the treatment for this pre-treatment estimate became necessary due to an accident that was not automobile-related or work-related, select this checkbox, and then enter the date (in a mm/dd/yyyy format) of the accident in the corresponding Accident Date box.
Note: Dentrix Enterprise automatically adds slashes to dates when you enter six or eight numbers (mmddyy or mmddyyyy) and then press the Tab key.
Attachments - You can include attachments with the pre-treatment estimate.
Dates Patient Unable to Work - The days that the patient has not been able to go to work. To specify a range, do the following:
In the first box, enter the start date (in a mm/dd/yyyy format).
In the second box, enter the end date (in a mm/dd/yyyy format) or today's date.
Note: Dentrix Enterprise automatically adds slashes to dates when you enter six or eight numbers (mmddyy or mmddyyyy) and then press the Tab key.
Related Hospitalization Dates - The days that hospitalization was required as part of the treatment for this pre-treatment estimate. To specify a range, do the following:
In the first box, enter the start date (in a mm/dd/yyyy format).
In the second box, enter the end date (in a mm/dd/yyyy format) or today's date.
Note: Dentrix Enterprise automatically adds slashes to dates when you enter six or eight numbers (mmddyy or mmddyyyy) and then press the Tab key.
Original Ref. No - For a voided or resubmitted Medicaid pre-treatment estimate, enter the original reference number.
Medicaid Resubmission Code - For a Medicaid pre-treatment estimate, enter the code that is required for resubmitting this pre-treatment estimate.
Prior authorization Number - If the pre-treatment estimate is approved, enter the pre-authorization number.
Note: If the pre-treatment estimate is approved, the pre-authorization number will automatically appear on claims.
10d. Reserved for Local Use - Enter the applicable code to identify additional documentation for the pre-treatment estimate. If you need to add more than one code, each additional code that you add must be preceded by three spaces.
Outside Lab? - If a third-party lab did any work for treatment on this pre-treatment estimate, select this checkbox. With this checkbox selected, in the Charges box, enter the dollar amount that will be charged for those services.
Note: For a whole dollar amount, you can enter a number without adding the decimal point and two zeros. For example, if you type 36 and then press Tab, Dentrix Enterprise will change the amount to 36.00.
Accept Assignment (Gov)? - If the provider of the procedures on the pre-treatment estimate accepts assignment of Medicare benefits, select this checkbox.
Date of Current Illness or Injury - If the treatment for this pre-treatment estimate became necessary due to an illness or injury, enter the date (in a mm/dd/yyyy format) of the onset of the illness or injury in the box.
Note: Dentrix Enterprise automatically adds slashes to dates when you enter six or eight numbers (mmddyy or mmddyyyy) and then press the Tab key.
First Date of Same or Similar Illness/Injury - If the treatment for this pre-treatment estimate became necessary due to an illness or injury that is the same or similar to an illness or injury the patient has had previously, enter the date (in a mm/dd/yyyy format) of the onset of the previous illness or injury in the box.
Note: Dentrix Enterprise automatically adds slashes to dates when you enter six or eight numbers (mmddyy or mmddyyyy) and then press the Tab key.
Name and Address of Facility where services were rendered - Where the treatment for this pre-treatment estimate will be performed. Do the following:
In the Facility box, enter the name of the facility.
In the larger box, enter that facility's address.
Note: To reset all the options in the Medical Insurance Claim Information dialog box to their default settings, click Clear. A confirmation message appears, reminding you that the pre-treatment estimate information will be cleared for this pre-treatment estimate and any other claims and pre-treatment estimates that include the procedures on this pre-treatment estimate. Click OK.
Click OK.