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Addresses on Claims

When setting up a Practice or Clinic, there are three options for addresses:

  • Physical treating address: Usually refers to the physical location where treatment is performed.
  • Billing address: It cannot be a PO Box. Generally used in e-claims but not paper claims.
  • Pay to address: Where the insurance payment will go. It can be a PO Box. Does not exist in version 4010 e-claims.

Below is an explanation of the logic that determines which addresses are sent in e-claims and printed claims.

E-Claims in 5010 Format
A billing address is required in e-claims and a pay to address is optional.

  • Billing address: Must be a physical address, not a PO Box.
  • Pay To address: Sent in addition to the billing address. Can be a PO Box. If left blank, the clearinghouse will consider the treating address the same as the billing address. Not sent in 4010 e-claims.

Open Dental determines an address using the logic below in this order.

  No Clinics Clinic attached to the claim
Billing Address
(version 15.3 and greater)

1. Practice Billing Address if 'Use on Claims' is checked
2. Practice Physical Treating Address

1. Clinic Billing Address if 'Use on Claims' is checked
2. Practice Billing Address if 'Use on Claims' is checked
3. Clinic Physical Treating Address

Pay To Address

1. Practice Pay To Address if not blank

1. Clinic Pay To Address if not blank
2. Practice Pay To Address if not blank
Billing Address
(version 15.2 and earlier)
1. Practice Billing Address if 'Use on Claims' is checked
2. Practice Address
1. Practice Billing Address if 'Use on Claims' is checked
2. Clinic Address

Service Facility address (place of service address): Sent in loop 2310C for 5010 dental e-claims when the following criteria is met.

  • At least one procedure on the claim must have a Site assigned (Procedures - Misc Tab). The first site attached to a procedure is used.
  • The site must have a valid address, city, state, and zip code.
  • The claim place of service is not 'Office'.
  • If no procedures have a site, or if the site provider and billing provider are the same, this address is not sent.

Notes:

  • 5010 e-claims require a 9 digit zip code for practice address. Visit https://tools.usps.com/go/ZipLookupAction_input.
  • Emdeon: If the Pay-To address is sent on an e-claim to Emdeon, then Emdeon will refer to the Pay-To address as the "Billing Address" on a claim detail printout (since it does not need to be a physical address). It will refer to what is normally considered the billing address as the "Rendering Address" since is must be a physical address. 
  • Many carriers began rejecting PO Boxes in the Billing address in 1/1/12. This applies to both 4010 and 5010 formats.

For more e-claim information, see E-claim Complexities.

Printed Claims
On a printed claim form there is usually an address for the Billing Provider and the Treating Provider. The field used for the billing provider address is usually PayToDentistsAddress. The field used as the treating provider is usually TreatingDentistAddress. The fields can be verified by looking at the Claim Form.

Open Dental determines which address populates these fields using the logic below in this order.

Field No Clinics Clinic attached to the claim
PayToDentistAddress

1. Practice Pay To Address if not blank
2. Practice Billing Address if 'Use on Claims' is checked
3. Practice Physical Treating Address.

1. Clinic Pay To Address if not blank
2. Practice Pay To Address if not blank
3. Clinic Billing Address if 'Use on Claims' is checked
4. Practice Billing Address if 'Use on Claims' is checked
5. Clinic Physical Treating Address.
TreatingDentistAddress Practice Physical Treating Address Clinic Physical Treating Address

 

 

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