Claim forms

There are many claim forms that you can link to providers. You can also use a form to create multiple forms with varying information, depending on the insurance carrier. You can then attach those forms to the corresponding insurance profiles. You can have up to 100 different claim forms.

To set up claim forms

1.   From the Report menu, point to Insurance, and then click Form Settings.

The Provider Form Link Table window appears.

2.   Select a line item, and then set up the following options:

·        Provider Link - Type a name for the form. This field has a limit of 15 characters.

·        Format - Select a claim format: <None>, Standard ADA Claim, CMS-1500 (Medical Claim), Standard CDA Claim Form, Denti-Cal Claim Form, Alabama Medicaid, Claim Transaction, NY Medicaid, Head Start, NJ Medicaid, Predetermination Trans, Claim Reversal, Eligibility Transaction, Outstanding Transactions, Summary Reconciliation, Payment Reconciliation, COB Transaction, Cigna Direct, CMS-1500 (red form), ADA Claim (red form), or ADA Claim.

·        Form Options

a.   Click Form Options.

The Set Print Form Margins dialog box appears.

b.   Select the line item that corresponds to the claim form you want to modify.

c.   For the form name, set up the following options:

·        Type the desired top margin amount in inches. The default is 0.250.

·        Type the desired left margin amount in inches. The default is 0.250.

·        Select a Sort option: Date, Provider, Entry Order or Date, Provider, Fee (Descending).

Note: Changing the margins may be necessary if you print claims on pre-printed forms. Also, a certain preference setting controls the reducing of claims to a percentage of their original size if your printer does not allow for printing with no margins.

d.   Repeat steps b - c for any other claim forms.

e.   Close the Set Print Form Margins dialog box.

·        Submitter ID - Submitter settings are used for printed and electronic claims. The Submitter ID settings will override the billing provider's information that was set up for the provider's form. Also, the Submitter ID settings will appear in the Billing Dentist section on ADA claim forms and in box 33 on HCFA claim forms. To set up submitter settings, do the following:

a.   Click Submitter ID.  If this button is not available, the selected claim format for the selected form number does not require submitter settings.

The Edit Submitter Settings dialog box appears.

b.   Set up the following options:

·        Name - Type the submitter's name.

·        Address  - Type the submitter's street address, suite (if applicable), city, state, and ZIP Code.

·        Phone - Type the submitter's phone number.

·        Tax Id Number - Type the submitter's tax ID, and select SSN or EIN.

·        Billing NPI - Type the submitter's billing NPI number.

c.   Close the Edit Submitter Settings dialog box.

·        Location ID - To set up the location settings, do the following:

a.   Click Location ID.

The Edit Location Settings dialog box appears.

b.   Select a Location, and type the Office Id.

c.   Close the Edit Location Settings dialog box.

3.   Repeat step 2 to define or edit any other claim forms.

 

Need more help?

You can visit our website, contact OMSVision Customer Support, or suggest a new feature or improvement on User Voice.