Providers who send both medical and dental claims, such as oral and maxillofacial surgeons, may need to use a combination of ADA and CPT codes in the office fee schedule. In some cases, the dental code has an equivalent medical code that simply needs to be used when submitting medical claims. By utilizing the cross code feature in the fee schedule, MacPractice will use the appropriate code, just based on whichever claim form you print/submit. This ensures you do not have to duplicate procedures in your patient's ledger or in your fee schedule. This article assumes you are running MacPractice DDS. For MD, DC, & 20/20 the steps remain the same, however, the dental or ADA code is entered as the Cross Code and the medical or CPT code is the default Code.
For paper claims, the office will first need to enable both dental and medical claim forms. This is done in the References ability by selecting the Forms node in the sidebar. Select the CMS 1500 NPI Only form and make sure the Form Active checkbox is checked. Save when you are finished. If your medical carriers request legacy PIN numbers on your claims, you may also decide to enable the CMS 1500 NPI and Legacy form. If you have not already activated your ADA 2019 form, you may do so at this time as well.
For electronic claims, you will need both the Capario_Dental eClaims template and the Proxymed medical eClaims template. Sending medical eClaims requires separate payer enrollments from Dental eClaims. Contact the MacPractice Enrollments department by email at email@example.com to begin payer enrollments with your clearinghouse. These templates will be installed during your eClaims training by a MacPractice representative.
Cross Code Setup
Once your forms or templates are ready, you will need to set up your cross code fees. In the References ability, select the Fee Schedules node in the sidebar and expand the sidebar to find your fee schedule. Select your fee schedule and select a code you wish to cross code. You should enter the dental or ADA code in the Code field in your fee schedule, then the corresponding medical or CPT code in the Cross Code field. Save when you are finished. Repeat these steps for each code you wish to cross code.
You may then create claims for these charges in your patients' ledgers. Leave your dental coverage set to the ADA 2019 form or the Capario_Dental eClaims template. MacPractice will use the code entered in the Code field on dental form/template. The ADA code is printed as normal in box 29 of the ADA 2019 form or its equivalent on an eClaim.
Be sure the medical claim form is used when submitting to medical insurance. The ADA code will be replaced with the cross code on the CMS claim form or Proxymed eClaims template. The cross code will be printed in box 24D of the CMS 1500 form or its equivalent on an eClaim.
If you have specific medical carriers, you may decide to make the CMS 1500 form the default form or the Proxymed template the default template for those carriers only. To do this, go to the References ability and select and expand the Insurance Companies node in the sidebar, then find your medical carrier. Select the Claims tab and set the eClaims Template and Default Form popup menus appropriately. Save when you are finished. With the correct template or form defaulted in the insurance reference, MacPractice will automatically choose the appropriate form for the medical coverage. Your dental coverage should remain defaulted to the Caprio_Dental template or the ADA 2019 form.