Claims (Advanced) tab

When adding and editing insurance profiles, use the Claims (advanced) tab to set advanced claims options for an insurance profile.

·        Put which amount on claims – Select which fee you want to have appear on a claim form. Fee in Fee Schedule (UCR) = Office’s normal fee set in fee schedule.

·        Amount Billed – The amount billed is the amount that is charged to a patient. This setting is usually used when the plan type is set to Indemnity. This is because these are non-participating plans. Therefore, the office can choose to change a charged amount, and that amount will appear on a claim form.

·        Fee in Fee Schedule (UCR) – The fee (UCR) is the office’s normal fee in the fee schedule. This setting is usually used when the plan type is set to PPO, DMO or Medicaid and has an estimator table set up to charge the insurance contracted amount (or allowable) but still submit the office’s full fee (UCR) on a claim form.

·       Eligibility Verification

·        Check every # months – Enter the number of months from the last time a patient’s insurance was verified to have the program alert you when it is time to verify his or her insurance again. The program will change the Last verified on date to have a red background when verification is due or overdue.

·        Claims – Select one of the following options:

·        Do not show on claim – To not have the eligibility code appear on a patient’s claim forms.

·        Show in place of Subscriber ID – To have the eligibility code appear in place of a patient’s subscriber ID on claim forms.

·        Show in place of Group/Plan # –To have the eligibility code appear in place of a patient’s group number on claim forms.

Note: You can enter the eligibility code on the Insurance tab of a patient’s PIC.

·        Claims default – Select a default option for claims:

·        Printed

·        Electronic

·        None

Note: You can change this for an individual patient when you are posting procedures.

·        Pre-tx default – Select a default option for pre-authorizations:

·        Printed

·        Electronic

·        None

Note: You can change this for an individual patient when you are treatment planning procedures.

·        Resubmit default – Select a default option for resubmittals:

·        Printed

·        Electronic

Note: You can change this for an individual patient when you are resubmitting claims or pre-authorizations.

·        Use doctor’s form settings when both a doctor and auxiliary are on the same claim – Select this check box if you have a doctor and an auxiliary staff member (such as hygienists) performs procedures on the same patient on the same day, and you want the auxiliary person to appear on the claim form with the doctor’s license and NPI information.

·        Claims: Allow Medical or Dental secondaries to be considered the ‘other’ plan – Select this check box if either of the following scenarios is true:

·        The plan is a dental plan, and you want any medical insurance that a patient has to appear as a secondary insurance on a dental claim form.

·        The plan is a medical plan, and you would like any dental insurance that the patient has to appear as a secondary insurance on a medical claim form.

·        Print primary payment info - When this setting is selected, the secondary insurance claim prints the primary insurance payment. Note: Some insurance companies want this information on the secondary claim, and some do not.

·        Bundle Exact Codes (Anesthesia Codes) - When this setting is selected, duplicate codes are bundled, rather than listed separately. (This may be necessary to comply with a policy from the ADA that insurance carriers bundle duplicate ADA codes on dental insurance claim forms.) When this setting is cleared, all duplicate codes listed.

·        Allow anesthesia units out to  __ digits past the decimal - Specify how precise you want anesthesia units to appear.  

·        Round anesthesia units - When this option is selected, anesthesia units are rounded (according to the Allow anesthesia units... described above).

·        Use SSN in place of Subscriber ID - When this option is selected, claims include the subscriber's Social Security number instead of the subscriber ID.

·        Show "tth" in claim service description - When this option is selected, claims include the "tth" abbreviation of "tooth" before tooth numbers. (Some payors may require that claims exclude this "tth" abbreviation.)

·        Use alternate location in claims file - When this option is selected, the second line of the (legacy) .rec claims file displays the billing address (which may be a different location from the physician's office). (Some payors may require this in the .rec claims file.)

·        Do not show duplicate address in box 32 of CMS-1500 form - When this option is selected, if the service facility location was the same as the physician's office, the duplicate address information is not repeated in box 32 of the form.

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