Default Insurance Billing/Treating Dentist Problem

[drtech]

I am trying to setup proper billing for a PPO plan and discovered a problem with setting the treating dentist on the insurance claim. If you complete procedures in hygiene that are all listed as the Hyg secondary provider, the "treating dentist" portion on the claim does not seem to default to what you setup in the practice setup as the "Default Insurance Billing Dentist" option. I can't figure out where it gets the treating provider, but it seemed to be random. I want the treating dentist to all be our default provider (or the one specified as the default Insurance Dentist) if not specified otherwise on the procedure itself. Using OD v13.1.34.

[jsalmon]

Definitely not random. Here's an example of how the treating provider is determined:
ContrAccount.cs > CreateClaim() around line 3037 in head.

Code: Select all

			ClaimCur.ProvTreat=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[0]]["ProcNum"].ToString())).ProvNum;
			for(int i=0;i<gridAccount.SelectedIndices.Length;i++){
				proc=Procedures.GetProcFromList(procsForPat,PIn.Long(table.Rows[gridAccount.SelectedIndices[i]]["ProcNum"].ToString()));
				if(!Providers.GetIsSec(proc.ProvNum)){//if not a hygienist
					ClaimCur.ProvTreat=proc.ProvNum;
				}
			}
			if(Providers.GetIsSec(ClaimCur.ProvTreat)){
				ClaimCur.ProvTreat=PatCur.PriProv;
				//OK if 0, because auto select first in list when open claim
			}

Let me know if you want that in layman's terms.

[drtech]

Ok, so it picks the primary provider. Shouldn't this pick the Billing Dentist instead? If not that should be added. I will soon make a request for a hook in for my plugin to add that option separately as the "Treating Dentist Default" if this is the way you intended it and not that way I was thinking...

[jsalmon]

No. You'll probably have to write your plugin. The reasoning is that some hospitals use the billing dentist as an "entity" and then the treating dentist is the doctor who actually performed the work. I believe claims will be rejected if you indicate that an "entity" performed a procedure.

[drtech]

The point is though that if you have hygiene procedures (secondary providers listed on the procedures) with no doctor doing any actual work at that appt, it should default to the default doctor that you should be able to specify as the treating dentist (not necessarily whoever is set in the primary provider field).