Tuesday, June 7, 2016

Just the Way They Like It--Customizing Insurance Claim Forms

Some insurance companies require specific adaptations to an otherwise standard form. In Dentrix, the Claim Setup dialog box allows you to select from several options to make these accommodations. These options are set up per insurance plan, so you can set the options just for the plans that require it and not for others.

Note: This customization is only available for the DX2007 and DX2012 claim formats.

To modify DX2007 or DX2012 claim settings:

  1. From the Office Manager, click Maintenance > Reference > Insurance Maintenance. The Insurance Maintenance dialog box appears.

  2. Select the insurance plan you want to customize and click the Ins Data button. The Dental Insurance Plan Information dialog box appears.

  3. Click the Claim Setup button. The Claim Setup dialog box appears.

  4. In the Formatting Options group box, set the Font Size and Date Format using the drop-down options.
  5. In the Provider and Fee Options group box, select the Fee Schedule to use from the drop-down options.
  6. In the Advanced Settings group box, select the options you want to set for claims associated with this insurance plan:
    Note: When you hover over any of these options with your mouse in Dentrix, a tooltip appears explaining what each option does. 
    • Use Patient's SSN for ID Number - Check this box to print the Social Security Number for the patient instead of the patient ID in box 15 of the claim form.
    • Print Completion Date in Remarks - Check this box to print the completion date (selected in the procedure entry) in addition to the procedure code in the Remarks for Unusual Services section of the claim form.
    • Print Primary Payment in the "Other Fee" - Check this box to have the primary insurance payment appear in the Other Fee box on the secondary insurance claim. If checked, secondary claims where this insurance is the secondary will print the primary payment in box 32 (DX2007) or 31a (DX2012) on the claim form. 
    • Use SSN for Chart Number - Check this box to print the patient's Social Security Number in box 23 of the claim, in place of the Chart Number.
    • No Arch, Sextant or Quad in 27 - Check this box to leave box 27 of the claim form blank when the procedure is assigned to something other than a tooth number (for providers who don't want quadrant or sextant information on the claim).
    • Print Primary Payment in Remarks - Check this box to print the primary insurance payment in the Remarks for Unusual Services section of the claim form.
    • Print 'No" for Claims Without Assignment of Benefits - Check this box to print the word "No" in the Subscriber Signature line (box 37 of the claim form) for patients who have not provided assignment of benefits to the provider.
  7. Click OK to save your changes and return to the Dental Insurance Plan Information dialog box.

  8. In the Insurance Claim Options group box, do one or more of the following:
    • Replace initial character of procedure code with - Check this box if the carrier requires ADA CDT-3 or CDT-4 codes and you have not converted all of your codes to this format. Type the appropriate letter to replace the initial character of each procedure code, such as "D".
    • Do Not Include Dental Diagnostic Codes - Check this box to exclude dental diagnostic codes on claims.
    • Do Not Include Group Plan Name - Check this box to exclude the group plan name from printing on the claim or from being sent electronically.
    • Do Not Bill to Dental Insurance - Check this box to prevent creating batch insurance claims for the carrier, to have Dentrix ask if you want to include or exclude procedures flagged as "Do Not Bill to Dental Insurance" when you create a claim, and to exclude procedures from the Procedures Not Attached to Insurance Report.
    • Print Name for Provider's Signature on Claims - Check this box to print the provider's name on claims instead of the provider's signature.
For additional information, see the Customizing Claim Formats and Editing Insurance Carriers topics in the Dentrix Help, or view our previous Tip Tuesday post titled Insurance Claims Setup.

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