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Claims Interactions

Claims Interactions
This document describes interactions between claims and other areas of MacPractice, such as References and the Ledger.

Provider User Reference
When submitting provider information on a claim, this information is pulled from the provider's User reference. The following screenshots describe which fields on the provider's User reference affect claims. The Privileges tab doesn't contain any claim-related fields.

User Information Tab
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  • Title: The Title is the provider's prefix, such as Dr., Mr., Mrs. and so on.
  • Provider's Last Name
  • Provider's First Name
  • Suffix: MD, DC, DDS, OD, and so on.
  • Is Provider: This checkbox must be checked in order for this user to be a considered provider in MacPractice.
Provider Numbers Tab
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  • Provider Shown on Claim: This pop-up menu controls which provider will be printed on claims. If this provider is the same provider shown on claim, this must be set to the provider's own User reference.
  • Name Printed in Box 33 or 53: This field controls what is printed in box 33 of the CMS-1500 form and box 53 of the ADA 2006 form when "Bill as Individual" is checked in the Insurance reference. It also controls what prints as the provider on statement forms.
  • Provider Taxonomy: The taxonomy code is the provider's specialty and is required for eClaims.
  • Group Taxonomy: The taxonomy code for the group should only be entered if specifically instructed to by the MacPractice EDI department.
  • Certification and Participates with Medicare: These checkboxes are informational only, neither of these checkboxes affect claims.
  • National Provider ID: The individual NPI number of the rendering provider. In the United States, all providers listed on claims must have an NPI number entered. MacPractice will validate the format of the number as you type, however this is not a guarantee that insurance will accept the NPI.
  • Group National Provider ID: The group NPI number of the billing provider. Not all providers or offices have group NPI numbers; leave this field blank if you don't have one. This field overrides the Office NPI number if entered.
  • Provider, Hospital, UPIN, Unique and Other: All these fields are informational only and do not affect claims.
  • Federal: Federal Tax ID (TIN or EIN)
  • SSN#: Social Security Number.
  • Sub ID: The Subscriber ID number should only be entered if specifically instructed to do so during your eClaims training or by the EDI department.
  • CLIA: The Clinical Laboratory Improvement Amendments number is only required for offices who submit laboratory procedures to Medicare.
  • DEA: The DEA number is not used on claims and will only print on prescriptions.
  • State License: The providers state license number should be entered for all dental providers. Some medical providers may need to submit the state license on some special-case Medicaid eClaims.
  • Title XIX SA Exception Code Box 25D: This number is only used for New York Medicaid claims.
  • Trading Partner Number: The Trading Partner Number should only be entered if specifically instructed to by the EDI department.
  • DPS: The DPS number is only used by prescriptions.
  • Mammography Certification: The Mammography Certification number should only be entered as needed for eClaims.
  • ABN: The Australian Business number is only used by Australian offices.
Provider Tax ID on Claims

The Provider Tax ID on Claims pop-up menu controls whether the SSN or TIN is used on insurance claims and must be set correctly.

Office Reference
When submitting office information on a claim, this information is pulled from the Office reference. The following screenshots describe which fields on the Office reference affect claims.
 
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  • Office Name and Office demographic information:
    • This information can not be changed by your office; you will need to contact the MacPractice Accounting Department to modify this information. The Physical Location tab should only be used under direction of the MacPractice EDI Department.
  • Having "Office Name Refers to an Individual" checked will turn on "Bill as individual" for all charges made with this Office Reference.
  • Default Facility: Setting the default Facility prevents you from having to fill out Facility information on every charge. A Facility entered in the charge window will override the Facility here.
  • Group NPI: The group NPI number of the billing provider. Not all providers or offices have group NPI numbers; leave this field blank if you don't have one.
  • Group Taxonomy: The taxonomy code for the group should only be entered if specifically instructed to by the MacPractice EDI Department.

Facility Reference
When submitting facility information on a claim, this information is pulled from the Facility reference:

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  • Facility Name and Facility Demographics can be added and modified as long as the user has Reference editing privileges.
  • Facility Tax ID: The Tax ID (TIN or EIN) of the facility is only printed on claims when sending legacy numbers.
  • Secondary Facility ID: California Medicaid Legacy Number, this number is no longer used or printed on claims.
  • National Provider ID: The NPI number submitted on claims for the facility should be the facility's billing or group NPI.

Laboratory Reference
When submitting laboratory information on a claim, this information is pulled from the Laboratory reference. The following describe which fields on the Laboratory reference affect claims:

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  • Lab Name and Lab Demographic information can be added and modified as long as the user has Reference editing privileges.
  • Lab Codes: Lab codes allow you to track Lab costs with production reports. Lab codes do not affect claims.
  • Lab ID#: The Tax ID (TIN or EIN) of the lab is only printed on claims when sending legacy numbers.
  • Secondary Lab ID#: The Secondary Lab ID # is no longer used.
  • National Provider ID: The NPI number submitted on claims for the laboratory should be the laboratory's billing or group NPI.
  • Referring Lab CLIA#: This field is only used when lab acts as a referring lab. This field should be left blank unless specifically instructed by the EDI department.

Referrers Reference
When submitting referring provider information on a claim, this information is pulled from the Referral reference. The following describes which fields on the Referral reference affect claims:

Referral Info Tab
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  • Title: The Title is the referral's prefix, such as Dr., Mr., Mrs. and so on.
  • Provider's Last Name or Organization Name
  • Provider's First Name
  • Suffix: MD, DDS, DC, OD, and so on.
  • Demographic Information: Referral demographics are not submitted on claims, it is only used for informational purposes.
  • Is Person: The Is Person checkbox is used on eClaims only to designate this referral as a person, as opposed to a non-person entity like a clinic.
  • Use on Claim: The Use On Claim checkbox is required for this referral to be shown on any claims in any capacity.
  • Choose Patient...: The Choose Patient checkbox creates a new patient referral, as opposed to a physician referral.
  • Taxonomy: The taxonomy code is the referral's specialty and is only required for special eClaims. The taxonomy will be sent if entered. Leave this field blank if you are unsure what the referral's taxonomy code is.
  • Phone Numbers: Phone numbers are not submitted on claims and are for informational purposes only.
  • Referral Type and Default Specialty: The referral type and specialty are used for reporting and informational purposes only.
Provider IDs Tab
All of these fields except for the NPI# will only pull when sending legacy numbers. The fields used are based on the plan type of the insurance or the referral override.
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  • UPIN Number or Left Blank
  • National Provider ID: Enter the rendering NPI number for a person, and the billing or group NPI for a non-person entity.
  • SSN/TID: Social Security Number or TIN/EIN may be entered in this field. This field requires an override to be set if needed on claims.
  • Medicaid: Medicaid claims may require the referral's Medicaid number. Leave this field blank otherwise.
  • Workers Compensation: Worker's comp claims may require the provider's UPIN number in this field. Leave this field blank otherwise.
  • State License: The State License number may be entered in this field. Leave this field blank otherwise.

Fee Schedule Reference
Most information associated to a fee in the fee schedule simply sets the default value that can then be overridden on the fly while posting. Fields that do not also appear while posting must be set in the fee schedule. The following describes which fields on the Fee Schedule reference affect claims:

Information on the Long Description tab does not print on claims.

Fee Tab
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  • Code, Short Description & Unit Fee: These fields describe the procedure the office will be using to charge the patient and are all required fields.
  • Cross Code: The Cross Code allows providers who send both Medical and Dental claims to use only one item in the fee schedule for both the Medical and the Dental code. MacPractice will use the appropriate code based on the claim form you print on.
  • Revenue Code (UB-92): Institutional Claims only
  • Demonstration Code: Institutional Claims only
  • PQRS: Having PQRS checked allows the New Claims Manager to pull $0.00 charges onto claims for PQRS. Also, procedures marked PQRS will not be included on any claims except for Medicare Part B claims.
  • Rate Code: Institutional Claims only
  • Procedure Type: The Procedure Type is only used in Insurance Estimating and Reports.
  • Procedure Category: The Procedure Category is only used in Reports.
  • Medically Necessary: Having Medically Necessary checked allows podiatrists to submit some charges electronically that would otherwise not be accepted. Please review the documentation on sending Medically Necessary eClaims here.
  • Default Provider and Default Office: These fields allow you to override the provider in the charge window from the patient's provider/office.
  • Lab/Facility tab: Use this option if this charge is always performed at the specified facility or lab. The facility or lab selected here will automatically be pulled into the charge window for this charge.
  • Place of Service: Designates where the services were rendered to the patient. This field is required for most claims.
  • Type of Service: Type of Service is not actually used on claims and is only informational.
  • Diagnosis: Use this option only if this charge is always associated to the specified Diagnoses. The Diagnoses selected here will be automatically associated to the charge when it is used in the charge window.
Specialty Tab
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  • Anesthesia: This area must be complete to use Anesthesia Billing. When a user enters a charge and the start and end time for the anesthesia, the Units are then calculated automatically. Click here for more information on anesthesia billing.
  • Medication: This area allows the user to associate a Medication Reference to a charge. When the charge is used, the Medication and NDC numbers are automatically associated to the charge and printed on the claim. MacPractice will also create an Rx record for the patient.

Insurance Company Reference
Insurance information on a claim is pulled from the Insurance Company Reference, which contains the Company Info, Claims, Provider IDs, Comments, and Plans tabs. When plans are associated to a patient's insurance, the Plan tab overrides information on the Company Info or Claims tab. The Comments tab doesn't affect claims.

Company Info
The Company Info tab sets demographic information for the Insurance Company.
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  • Insurance Company: The Insurance Company name used to identify this insurance. It will appear in the sidebar under the Insurance Companies node. The name will print above the address on a paper claim and is also sent on electronic claims.
  • Street Address, Suite, City, State, and Zip Code: Demographic information that would pertain to the company as a whole. If using insurance plans, the demographic information will be pulled from the Demographic information under the Plans tab, not from the Company Info tab.
  • Phone, Extension, Contact Person, Fax, and E-mail Address: Additional demographic information. Within plans this information is stored in the Demographic information under the Plans tab. These fields are informational only and do not print on claims.
  • Default Fee Schedule: The fee schedule associated to the carrier when an insurance is added to the patient's account. This is different than the fee schedule on the account, the user will be prompted if they want to change the patient's fee schedule to match that of the insurance.
  • Previous Plan Name: Used for Informational purposes only.
  • Practice Group ID (Paper) and Practice Group ID (Electronic): These fields correspond to the Group PTAN number. If the Group PTAN is unknown leave this field blank as an erroneous number may cause invalid eClaims. Additionally, this number is only used when sending legacy numbers.
  • Claim Office: Leave this field blank unless specifically instructed by the EDI department. Only a few payers require this information.
  • Payer ID: Used by eClaims to identify the payer. Payer IDs are specific to each clearing house to the Clearinghouse
  • Submitter ID: The Submitter ID is used for specific eClaims payers. Leave this field blank unless specifically instructed to by the EDI department.
  • Trading Partner Number: The Trading Partner Number is only used in special circumstances and should only be entered if specifically instructed to by the eClaims department.
  • Carrier Code: The Carrier Code may be required for some Medicaid payers for secondary claims, but only in special circumstances. Leave this field blank unless specifically instructed by the eClaims department.
  • Website: The payer's website is for informational purposes only.

Claims Tab
The Claims tab contains information related to claims for an insurance carrier.
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  • eClaims Template: Sets the default template used when creating claims from the ledger. Set it to None if payer does not accept electronic claims. Setting a template in the insurance reference will cause MacPractice to override the default paper form and always default to an eClaim in the claim creation sheet. The defaulted value can be selected manually when creating claims. 
  • Default Form: Sets the default paper form to use when creating claims from the ledger. Setting this allows to choose the correct form whether legacy, NPI, or both should go on a claim to this carrier.
  • Plan Type: The Plan Type sets the legacy qualifier code and various other fields on both paper and electronic claims. The Plan Type is a critical setting for claims and Medicare, Medicaid, and Blue Cross/Blue Shield especially need this setting to be correct.
  • Carrier Always Pays Provider: If a provider does not accept assignment and creates a claim on the ledger, the balance of the claim will remain in patient portion. Checking Carrier Always Pays Provider keeps the charges submitted in the Insurance Portion until claim is paid/closed.
  • Write-Off Lab: Currently does not control any other feature in MacPractice.
  • eClaims should include NPI only: Forces all eClaims for this payer to be sent without the legacy provider number in all areas of the claim.
  • Use Group Taxonomy: Sends the group taxonomy code as well as the provider's taxonomy code when checked. This setting only affects eClaims. MacPractice will notify you if you need to send a group taxonomy code. 
  • Sum the following in Box 29 HCFA for Secondary Claims: These checkboxes allows the User to control if Patient Paid, Primary Paid or Insurance Write-Off are included in the calculation of Box 29 on the CMS 1500 form. They are used for secondary paper claims only and do not affect eClaims
  • Sum following in Box 29 HCFA for Primary Claims: This checkbox allows the User to control if Patient Paid is included in the calculation of Box 29 on the CMS 1500 form. It is used for primary paper claims only and do not affect eClaims. Please keep in mind for eClaims if a patient payment is applied to a charge prior to claim creation, the patient payment will always appear on the eClaim.
  • CMS 1500 Legacy ID Codes: These pop-up menus allow the user to control the legacy qualifiers and/or legacy number on paper claims only. The Automatic setting will pull the qualifiers based on the Plan Type and will work in most cases. eClaim qualifier codes are controlled by the template.
    • Legacy Referral Qualifier Code: Controls box 17a, a two digit qualifier code which defines the type of legacy number being sent. The qualifier prints before the legacy number in this field. When set to Automatic, the code is set based on Plan Type.
    • Legacy Referral ID Number: Controls box 17a to pull the legacy number from an alternate field in the Referral Reference. Normally the referral legacy number pulls from the field corresponding to the Plan Type.
    • Legacy Facility Qualifier Code: Controls box 32b, a two digit qualifier code which defines the type of legacy number being sent. The qualifier prints before the legacy number in this field. When set to Automatic, code is set based on the Plan Type.

Provider IDs Tab
Each line in the Provider IDs tab has several columns. Use the scrollbar to reveal all of the columns.

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  • Paper ID: This field corresponds to the provider's individual PTAN number for paper claims. Leave this field blank if you do not have a specifically assigned PTAN or legacy ID number for this carrier. This number is only used when using one of the Legacy ID claim forms.
  • Electronic Claims ID: This field corresponds to the provider's individual PTAN number for electronic claims. Leave this field blank if you do not have a specifically assigned PTAN or legacy ID number for this carrier. Check with your Payer ID list to determine which identifiers are submitted electronically.
  • Submitter ID: The Submitter ID is only used for specific payers for eClaims. Leave this field blank unless specifically instructed to by the eClaims or Enrollment departments.
  • Legacy Type Override: This pop-up menu grants additional control over which tax ID is sent on claims, either the provider's federal tax ID or Social Security Number. This should not be set unless this carrier wants something different than every other carrier.
  • Participate: Check this box if your provider has a participating contract with this insurance carrier. Contact your payers if you are unsure whether you participate or not.
  • Provider Accept Assignment: Check this box if your provider accepts this carrier's allowed amounts. This checkbox also controls whether the claim moves the balance to the insurance portion when a claim is created and Insurance Estimating is not turned on. Contact your payers if you are unsure whether you should check this box or not.
  • Bill as Individual: Having "Bill as Individual" checked will strip off all group identifiers from a claim and print only individual identifiers instead. This should only be checked in instances where an insurance company has you on file as an individual where other carriers have you on file as a group. If you have any questions about this checkbox please contact the MacPractice Support Department.
  • Qualifier Code (box 24): Used by paper claims only when sending Legacy information. Only change from Automatic if instructed.
  • Practice Group ID (Paper): This field overrides the Practice Group ID (Paper) field on the Company Info tab. Only enter a number here if you need to enter multiple group PTAN numbers for multiple providers.
  • Practice Group ID (Electronic): This field overrides the Practice Group ID (Electronic) field on the Company Info tab. Only enter a number here if you need to enter multiple group PTAN numbers for multiple providers.
  • Group Qualifier Code (box 33): Used by paper claims only when sending Legacy information. Only change from 'Automatic' if instructed.

Plans Tab
Any information entered under the Plans tab of the Insurance Company reference will override information entered on the Company Info tab, as long as the patient has a plan associated to their insurance. Information entered on the Notes tab doesn't affect claims.

Plan Coverage Tab (Claims)
Most fields on the image below are used in setting up Insurance Estimating and will not affect claims printing and/or creation
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  • Participate: Controls whether a write-off is automatically calculated when the plan is set up for the patient. Having Participate checked here also overrides the Participate setting on the Provider IDs tab.
  • Plan Type: Overrides the Plan Type on the Company Information tab as long as the patient has a plan selected.
Plan Coverage Tab (Insurance Estimating)

  • Plan Name: Plans are used to modify the patient's coverage for the particular insurance. There can be many plans used by a single insurance company. Plans can be named in many ways, most commonly plans are named after an employer, group or by the plan address.

    These fields will pull forward into the patient's screen allowing the office to keep track of plan information for Insurance Estimating. This information can also be overridden on a per-patient basis.
  • Coordination w/Other Carriers: Controls how Secondary Insurance Estimating behaves in coordination with Primary coverage.
  • Deductible Applied To: Determines how many patients on the account must meet the deductible before an insurance portion will be calculated.
  • Procedure Type: Lists each Procedure Type you have created in your database.
  • % Insurance Pays: The percentage of an allowed amount that you expect to receive from the payer per their plan specifications.
  • Applies to Deductible: Determines whether the procedure type will apply toward a patient's deductible.
Plan Demographic Tab
All Insurance demographic information entered here will override the demographics on the Company Information tab if the Plan is associated to the patient. If an insurance claim prints with a blank insurance company address, and the address is entered correctly in the Company Info tab, confirm the address is also entered correctly in the Plans > Demographic tab.
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Plan Participation Tab
The Participate tab allows users to control the plan's participation per provider; this information overrides the participation checkbox on the Coverage tab per provider.
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Procedures Tab
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  • Procedure Code: The code for the procedure in the plan.
  • Allowed: The amount that insurance has agreed to pay.
  • Flat Rate: The rate that insurance will always pay regardless of the situation.
  • Copay: How much the patient's Copay will be for the procedure.
  • Work RVU: The Relative Value Units are entered here should they be required.

Ledger
The following documentation describes which fields in the Ledger affect claims.

Incident Level Information
When entering information on the Incident level, only newly created charges and claims will be affected. Entering information to the Incident will never retroactively change any information on claims or charges. To access the Incident, be sure to select the incident name in the sidebar. Information on the Military or Attorney tabs do not print on claims.

Incident Tab
The Incident tab will look different depending on which MacPractice product you are using. If you are using MacPractice MD, DC, or 20/20, reference the following screenshot.

  • Incident Date, Incident Name, and Incident Type: These are all used as informational fields. The Incident Date will default the to the date of the first procedure that is entered into the ledger and the Incident Name is a required field when creating an incident.
  • Referral Source: A referral entered in this field will be automatically populated in all new charges created in this incident.
  • Reason for Treatment: Allows accident information to be entered for all new claims created in this incident.
  • Box 19: When used, the information entered into this area will appear in box 19 on paper claims, and as claim-level notes on eClaims.
  • Facility: A facility entered in this field will be automatically populated in all new charges created in this incident if the appropriate Preference is enabled in Preferences > Ledger > New Charge > Always Pull Facility From Incident.
  • Occupational Illness/Injury & Prosthesis: These fields are only used on paper Dental claims.
If you are using MacPractice DDS, reference the following screenshot.

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  • Incident Date, Incident Name, and Incident Type: These are all used as informational fields. The Incident Date will default the to the date of the first procedure that is entered into the ledger and the Incident Name is a required field when creating an incident.
  • Referral Source: A referral entered in this field will be automatically populated in all new charges created in this incident.
  • Reason for Treatment: Allows accident information to be entered for all new claims created in this incident.
  • Facility: A facility entered in this field will be automatically populated in all new charges created in this incident if the appropriate Preference is enabled in Preferences > Ledger > New Charge > Always Pull Facility From Incident.
  • Occupational Illness/Injury & Prosthesis: These fields are only used on paper Dental claims.
  • Orthodontics: Check this box to indicate the procedures performed in this incident are orthodontic. This affects both paper and electronic claims.
  • Initial Placement: This field is for informational use only.
Claims Tab
The Claims tab will also be different depending on your MacPractice product. If you are using MacPractice MD, DC, or 20/20, reference the following screenshot.

  • Partial Disability and Total Disability: These fields are typically only used for Workman's Comp claims to identify the patient's disability information.
  • Box 23B and Box 25C: These fields are only used for New York Medicaid claims.
  • First Symptom: Choose the appropriate option for the patient's first symptom. The First Symptom date will not print on paper claims if this pop-up menu is set to None or Routine Services.
  • First Symptom and Similar Symptom: Will print on both paper and electronic claims.
  • First Consultation and Last Seen: Enter the patient's Initial Treatment date in the First Consultation date field in order for this date to be accurately reported for eClaims. The Last Seen date will also only be sent on eClaims.
  • Assumed and Relinquished: These fields are only used on eClaims in the event one provider assumes care from another provider for a patient.
If you are using MacPractice DDS, the below fields will only affect the Dental paper claims.
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Prior Auth Tab
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  • Prior Authorization: This field is for the prior authorization or predetermination number that an insurance Company assigns for this patient for services.
  • Insurance Company: The Insurance Company must be selected for the Prior Authorization to work.
  • Total Visits: Enter the number of visits the Insurance Company has approved for the patient.
  • Remaining Visits: The number of visits the patient has left that are authorized by the Insurance Company. This number will count down as claims are created. Even if an insurance company did not authorize a specific number of visits, a patient must have remaining visits for the prior authorization to be pulled on claims.
  • Expiration Date: Controls whether this prior authorization expires on a specific date or not. If the expiration date is unknown or not specified, leave this field blank.
  • Start Date: Controls whether this prior authorization starts on a specific date or not. If the start date is unknown or not specified, leave this field blank.
Resource Tab
These area allows for additional information to be entered to assist with the submission of eClaims. Clicking the plus button will open up a pop up menu where you can select from:
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  • Extraction
  • Material Forwarded
  • Orthodontics
  • Paperwork
  • Prosthesis

Charge Window Information
Many of the other references mentioned, such as the Referral, Facility and Lab references, must be associated to the charge in the charge window in order to appear on claims. Many of the values shown in the charge window can be defaulted in the Fee Schedule reference, but can always be overridden on the fly while posting.

The New Charge window will look different depending on what MacPractice product you are using. Be sure you are referencing the correct section.

MD, DC, 20/20: New Charge Window:

  • Fee Schedule: Pulls from the patient screen by default but may be overridden on the fly.
  • Procedure Date: Auto-fills with todays date and can be manually adjusted as needed. This indicates the date the services were actually rendered to the patient.
  • To Date: The To Date should only be entered when procedures span multiple dates.
  • Provider and Office: These fields pull from the patient tab, unless specified on the charge in the fee schedule. You can always override the provider on the fly. The Provider listed in the charge window will appear in production reports and will be credited as earning any money applied to this charge in the Earned Receipts report.
  • Code: Enter the appropriate code in this field for the performed procedure.
  • Procedure Type: The Procedure Type is used for Insurance Estimating to pull the proper insurance coverage percentage for the selected procedure.
  • Procedure Category: The Procedure Category is used for reporting purposes only.

    These fields will all pull from the fee schedule but can be manually overridden on the fly.
  • Referral: The referral will be automatically populated from the Incident if available. The Referral must appear here for it to appear on a printed claim.
  • Facility: The facility will be automatically populated either from the Incident area or the Fee Schedule but can be overridden on the fly.
  • Diagnosis: Double click to search for a diagnosis or enter one by typing in the appropriate code. You can also enter diagnoses on the code in the Fee Schedule to have it automatically populated in this window. Diagnoses entered on the Patient Diagnosis tab will be automatically populated in this window if the Use checkbox is checked.
  • Admitted Date and Discharge Date: These dates indicate on a claim when the patient was admitted or discharged from the facility. LOS, or Length of Stay is calculated from the dates entered and is just for informational use.
  • Lab information: Can be pulled from the Fee Schedule or entered on the fly. An eClaim can not have both a Facility and a Lab on a charge. If this is done the claim will be rejected.
  • Plus Button: The plus button allows you to add additional procedure codes. Entering new codes using the plus button will preserve the settings from the first charge entered.
  • Enter Payments After Saving Charges: If this is checked, MacPractice will open up the patient payment window when the charge is saved.
MD, DC, 20/20: Specialty tab, Notes tab , Rx tab:

Specialty tab: The Specialty tab is used by offices that send both Medical and Dental claims to indicate Dental information on paper and electronic claims.

Notes tab: Information entered here will only be used on electronic claims on the procedure level. Only put notes in this field if they are specific only to this procedure. Notes on the claim as a whole should be entered in the Box 19 field on the Incident screen. Information entered in this field will not pull to paper claims.

Rx tab: The Rx tab is used on Medical claims to attach a medication and NDC number to both paper and electronic claims.

DDS: New Charge Window:
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  1. Fee Schedule: Pulls from the patient screen by default but may be overridden on the fly.
  2. Procedure Date: Auto-fills with todays date and can be manually adjusted as needed. This indicates the date the services were actually rendered to the patient.
  3. Provider and Office: These fields pull from the patient tab, unless specified on the charge in the fee schedule. You can always override the provider on the fly. The Provider listed in the charge window will appear in production reports and will be credited as earning any money applied to this charge in the Earned Receipts report.
  4. Code: Enter the appropriate code in this field for the performed procedure.
  5. Procedure Type: The Procedure Type is used for Insurance Estimating to pull the proper insurance coverage percentage for the selected procedure.
  6. Procedure Category: The Procedure Category is used for reporting purposes only. These fields will all pull from the fee schedule but can be manually overridden on the fly.
  7. Referral: The referral will be automatically populated from the Incident if available. The Referral must appear here for it to appear on a printed Medical claim. If not needed, you may leave this field blank.
  8. Facility: The facility will be automatically populated either from the Incident area or the Fee Schedule but can be overridden on the fly.
  9. Diagnosis: Double click to search for a diagnosis or enter one by typing in the appropriate code. You can also enter diagnoses on the code in the Fee Schedule to have it automatically populated in this window. Diagnoses entered on the Patient Diagnosis tab will be automatically populated in this window if the Use checkbox is checked. If not needed you may leave this field blank.
  10. Lab information: Can be pulled from the Fee Schedule or entered on the fly. An eClaim can not have both a Facility and a Lab on a charge. If this is done the claim will be rejected.
  11. Plus Button: The plus button allows you to add additional procedure codes. Entering new codes using the plus button will preserve the settings from the first charge entered.
  12. Enter Payments After Saving Charges: If this is checked, MacPractice will open up the patient payment window when the charge is saved.
DDS: Notes tab, Specialty tab, Attachments tab:
  1. Notes tab: Notes entered here will only be used on claims if the "Print As Remarks on Claim (Box 35)" checkbox is checked. Notes can be attached to both paper and electronic claims.
  2. Specialty tab: Data entered on this tab is used for informational purposed only and will not appear on claims.
  3. Attachments tab: Attachments are only available for Dental eClaims submitters who have purchased the NEA FastAttach feature.
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