Medical Insurance Claim Info

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savvy
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Joined: Wed Sep 12, 2007 9:25 pm
Location: Berkeley, California

Medical Insurance Claim Info

Post by savvy » Wed May 16, 2012 10:57 pm

SUSPECT BUG edited 5/17/12 6PM
SEE MY SECOND POSTING BELOW


OK, I've done my research.
I'm ready to bill my first medical claim........
Problems!!
1. I can not fill out the form fully
2. There is not enough conversion info available.
3. Open Dental will not let me enter the info manually.

I need, and I assume most need if one is using medical claims , to be able to fill out all the fields.

For example:
Patient is referred by head team physician due to trauma resulting in loss of tooth and lacerated lip.
The following info needs to be added:
#14 Date of Injury
#17 Name of Referring Physician (Team Physician)
#17a Physician NPI Number (Team Physician NPI)
#19 Additional Diagnosis Codes
#20 Outside Lab (Was A Dental Lab Used) Y/N Lab Charge (Lab Fee for Flipper)
#21 Primary Diagnosis Codes (525.11 Loss of Teeth Due To Trauma; 935.0 Foreign body in mouth; 873.53 Open Wound to Lip)
#23 Prior Authorization Number (Received after Medical Need Letter approved)
#24b Place of Service (O=Office)
#24c Emergency Treatment (Y/N)
#24d Modifiers (E917.0 Struck Accidentally by object or person in sports; E928.3 Human Bite)
#24f Charges (needs to be able to adjust to total charges indicated by #24g Units ie: 4 films (4 units) @$25 each $100 (total charge) goes in box 24f)
#24g Units (how may periapicle radiographs)
#29 Balance Paid by Primary Insurance (if billing secondary)
#30 Balance Due

Also, where does one keep a list of the ICD-9 Diagnosis Codes, Modifier V and E Codes, Procedure Codes?

Cheers for now!
Last edited by savvy on Thu May 17, 2012 6:02 pm, edited 3 times in total.
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

bcpayne
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Re: Medical Insurance Claim Info

Post by bcpayne » Thu May 17, 2012 6:27 am

As far as the diagnosis codes go, the only place I have found a list is in the medical history window, where you add diagnosis or problems for the patient. No functional list that would allow selecting a diagnosis from a list for a procedure. So unfortunately I still have to keep my icd 9 book next to me on my desk.
Its not clear whether you got the first dx code to show up on the form. Open the procedure you are going to bill and put it in the diagnosis code box.
As for the procedure code, some medical insurances will allow billing of dental codes, some want the CPT code. In my procedure list I have added separate procedures for the CPTs I use when billing medical. The other option is opening the procedure you completed and typing the cpt in the medical code box.
I am not sure how far my biller has gotten with all the other boxes but ill ask.

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savvy
Posts: 438
Joined: Wed Sep 12, 2007 9:25 pm
Location: Berkeley, California

Re: Medical Insurance Claim

Post by savvy » Thu May 17, 2012 5:59 pm

BUG

Alright, I found how to add fields onto a copied claim form.
I've just about completed it, but need help from Jordan and Co.

I believe this can be considered a bug as it relates to an already implemented feature.

The Referring Physician needs to have an NPI number associated with it. Currently, it must be entered manually as the initial entry is not mapped.
The Diagnosis 1, 2, 3 and 4 need to have associated Modifier Fields. IE: Diagnosis 1= 525.11 Loss of Teeth Due To Trauma, with the Modifier E917.0 Relating to Sports

In the PROCEDURE INFO Medical and Institutional section, added to the drop down area should be a field for Outside Lab Y or N and Lab Cost.
In the Medical Claim Field Listing there should be fields for OutsideYESlab, OutsideNOlab, and LabCost

THANKS!
Cheers!!!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

bcpayne
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Re: Medical Insurance Claim Info

Post by bcpayne » Thu May 17, 2012 9:08 pm

regarding the referring physician issue, we bill medical frequently but have never needed to include the referring dr on the claim. It is a box that rarely gets used. Also there are very few insurances that won't allow you to just handwrite in the items not automatically included. That being said, I hope we can get the wrinkles like this out of medical claim forms.

About box 20. This is made for the case that you are billing for a service charged by someone else. Like if you ordered and paid for a blood test and you are charging the insurance for it. Most lab fees as pertains to dentistry wouldn't apply, since you aren't charging for the physical lab production of a crown, the cost is included in your entire service for placing a crown.

About box 24d. The modifiers that you put in these boxes are not for the diagnosis, such as E codes. These are for modifiers to medical procedure codes. like the 50 in 21470.50 these better explain the service provided. like 50 for bilateral procedure or 82 for assistant surgeon. if you are using dental codes then these likely won't pertain.

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savvy
Posts: 438
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Location: Berkeley, California

Re: Medical Insurance Claim Info

Post by savvy » Thu May 17, 2012 10:20 pm

Thanks bc,

As you can tell, I'm new to this.
Perhaps I'm the example that "a little knowledge is dangerous."
I'm just following the instruction of a lecturer and handout from a CDA meeting.
As for referral physician, most of my medical claims are intercollegiate competition related.
In the past, dental treatment has been excluded.
In fact, by just looking at NCAA surveillance data, one could conclude that there are virtually no oral/facial injuries.
To change that, one must "follow the book" and "play by the rules" that tend to change when "goal posts are moved."
Clearly, you must be experienced in this.
Keep your insight coming.
It is greatly appreciated.
Cheers!!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

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jordansparks
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Re: Medical Insurance Claim Info

Post by jordansparks » Fri May 18, 2012 6:41 am

Not a bug. ReferringProvNPI is already an available field. I suspect that a few others are also already available. You might need to edit the Claim Form yourself to get them on there. Our planned solution for claim forms is to move them over to Sheets so that we can better maintain the default claimform layout and so that the user could add misc fields and manually edit before sending. But we are very responsive to adding missing fields if people really need them.

For managing ICD9, just do a search in our manual.
http://www.opendental.com/manual/icd9.html
Jordan Sparks, DMD
http://www.opendental.com

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savvy
Posts: 438
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Location: Berkeley, California

Re: Medical Insurance Claim Info

Post by savvy » Fri May 18, 2012 7:06 am

Jordan,
thank you for your response.
I have edited the claim form.
Yes, the Referred Physician Number is a field.
The problem is that when one adds the name of a referring physician and NPI number in the REFERAL section of OD, the NPI number does not appear to be associated with the dr in the CLAIM section of OD.
In the CLAIM section, Referral Section of OD there is a Search drop down for Referring Physician.
Unfortunately, when one selects the provider, the NPI number does not appear.
It must be manually entered.
The field in this section is called Referral Number, and it is here that the NPI number is placed.
The NPI number does not map from the Patient Info Referral field to the Claim section Referral Number field.
Go ahead and try it.

Adding the other fields would be great.

Just trying to help make OD GREAT!

Cheers!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

smileyguy
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Joined: Mon Jun 25, 2012 8:35 pm

Re: Medical Insurance Claim Info

Post by smileyguy » Mon Jun 25, 2012 8:38 pm

I have a few questions regarding using OD's medical claim form.

1. On Form 1500 there are 4 spaces for entering diagnostic codes and 4 separate spaces for entering modifier codes. However with OD in the patient record there is only 1 space for entering the diagnostic codes. Is this an error or do we use commas to separate the codes? If we use commas then how do we indicate which code is the primary diagnosis?

2. For medical billing we usually have to submit supporting attachment such as a Letter of Medical Necessity (LMN) or test results, etc to get a Pre-Determination. My understanding from Emdeon is that they don't support this. OD's staff mentioned that NEA Fast Attach has a product for support medical called MEA. Does OD will work with MEA?

3. OD support mentioned to me that OD has a few clients that somehow separate medical claims A/R from the dental A/R by running two separate databases for A/R. If so, how can we do this?

4. Can we create a database or list of most frequent medical diagnosis codes to choose from?

5. For medical procedure codes that don't have a dental cross code can we create codes to choose from in a Medical Procedure Code section?

Thank you.

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jordansparks
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Re: Medical Insurance Claim Info

Post by jordansparks » Wed Jun 27, 2012 9:56 pm

1. In column E, there is only room for one diagnosis pointer per procedure. The pointers point to one of the 4 codes above. So there might be multiple procedures pointing to the same code above.

2. If MEA works the same as NEA, then all that is required is for you to put the MEA number in the remarks. There is nothing that we need to add to make this work.

3. That's a complicated question. If you use two separate databases, then they would be truly separate and isolated. I don't think this is what you really want. Are you talking about wanting the outstanding insurance claims report to filter for medical insurance?

4. We have ICD9 codes built in, but it's the full list. I think we make you type in the ICD9 in the procedure edit window. It would be a feature request to add another table to the database or something similar in order to hold the favorites.

5. Yes, of course. At least if I understand your question correctly.
Jordan Sparks, DMD
http://www.opendental.com

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