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Edit Claim - Misc Tab

The Edit Claim window, Misc tab, has fields that apply to Denti-Cal information and other fields that are not used often.

Correction Type:  In E-claims this field corresponds to the Claim Frequency Code and is used to fix mistakes on e-claims that have already been sent. It was added for Denti-Cal direct integration, but can be used for other carriers as well. There are three possible correction types.

  • Original: Select this type for the first submission of any e-claim. Sends a value of '1'.
  • Replacement: Select this type if you realize, after submitting an e-claim, that some of the reported information is incorrect. Then resend the claim. The carrier will ignore the original claim and instead use the new replacement claim. Each carrier has their own policy on whether or not they accept replacement e-claims and what kinds of corrections they will allow in replacement claims. Contact the carrier for their policy. Sends a value of '7'.
  • Void: Select this type if an e-claim was sent entirely in error, then resend the e-claim to cancel the original claim. Most carriers do not support this correction type. Sends a value of '8'.

To improve chances of acceptance, send Replacement and Void claims as soon as possible after the original claim is sent.

Prior Authorization (rare): Typically used for medical claims. Shows on printed and e-claims. On printed claims, the number shows in the PriorAuthorizationNumber field.

Special Program: Only used for e-claims in the 5010 format. This is sent on preauthorization e-claims when the value is set to a something other than none.

Default Claim Identifier: A unique identifying number for each claim. Open Dental automatically generates this number. By default, the PatNum is used as the prefix. To select a different prefix, change the Claim Identification Prefix under Account module preferences.

Claim Identifier (CLM01): A unique identifying number for each claim. Open Dental automatically generates this number using the format PatNum/ClaimNum. It can be manually edited when creating the claim, but once the claim is saved it cannot be changed. It is used to match an electronic EOB (ERA's) to the original claim. 

Original Reference Num: Required by insurance when voiding a claim or replacing a claim by setting the CLM05-3. This number is given by the insurance.

Share of Cost Amount: Rarely used. It is the sum of all amounts paid specifically to this claim by the patient or family. Sent in e-claims.

Also see E-Claim Complexities

 

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