Insurance claim format

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This topic contains 3 replies, has 3 voices, and was last updated by  Dayna Johnson – founder and CEO of Novonee 8 months, 1 week ago.

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    Elite Dental Care

    Wondering which claim format to use so that our PPO fees will be charged out to the patient and show up on their ledger, but will also send our office fees to the insurance company. The way it is set up now, we are sending in the PPO fees to the insurance company. Thanks!


    If you want to post the PPO fees to the patient ledger and the treatment plan and then send the full office fee to the insurance company then use the DX2012F claim format.

    You can update your claim format in the Definitions. Go to the Office Manager > Maintenance > Practice Setup > Definitions, then in the drop down menu click on Claim Format and there will be a list of claim formats listed. If the DX2012F is not listed you can change the top one listed. Highlight it and change it to DX2012F and then click on Change. If you change the top one it will usually do a global change so you don’t have to manually change it on all the insurance plans.

    Hope this helps. Let me know if you still have questions.


    David Bistritz

    How do I change the fee schedule on that claim format? I made a fee schedule that is higher than our UCR fees and insurance fees. How can I add that fee schedule to the claim format?


    There are two claim formats to choose from, the DX2012 and the DX2012F. The DX2012 will pull the fees reported on the patients ledger. The DX2012F claim format will IGNORE the ledger and pull the fee schedule that is attached to the insurance company or the fee schedule listed in the patients Family File.

    You can assign the fee schedule and the claim format to the insurance plan from the Insurance Info in the insurance box on the Family File or on the insurance maintenance on the Office Manager.

    So to answer your specific question . . . You don’t actually assign the fee schedule to the claim format, you assign the claim format to the insurance plan. If you have a higher fee schedule that you want to bill to a specific insurance company then attach the fee schedule to the insurance plan info with the DX2012F claim format. So if you post lower fees to the patients ledger it will put the higher fees on the claim form.
    Let me know if you have questions.

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