Prime Smile Dentistry, pg 71
There are eight tabs across the top of each claim. The first three tabs contain the necessary information to complete your ADA J430 form.
1. Claim: Contains treating and billing dentist; insurance information; and claim preauthorization #.
2. Charges: Enter all CDT codes, diagnosis codes, and all relevant charges and payments.
3. Additional Info: Contains missing teeth, claim dates, and accident information, if provided.
4. Insurance: View the patient’s current payer ID numbers.
5. Activity: Shows transactions for this claim.
6. Notes: Not applicable.
7. Alerts: Not applicable.
8. Documents: Not applicable.
Add a New Claim to a Patient
Before assuming you need to Add a claim, it is important to verify the number of claims your assignment requires (see the previous information).
To add a claim into the system, click the Add Claim button. Next, click the Blank Claim or the Add for Patient Name button.
2. If you click the Add for Patient Name option, the active patient that is displayed at the bottom left of the software will populate in
You can retrieve an existing claim to fix errors. To find a claim, click the Find button or Find for Active Patient button.
Place your cursor in the Search field and type in either part of or the full patient’s first or last name. The results will filter all patients with these specific characters found in the database and display them alphabetically in an organized table. Always search here first to determine whether the patient and claim are already in the system to prevent duplicate claim entry. All saved claims will display here. Click the Search button.
default, and complete the remaining fields.
* Should be defaulted from the initial Patient entry.
2. Claim Complete: All claims will be checked as “Claim is complete,” unless when you click to Save the claim, an information
screen informs you that this claim is incomplete and asks if you would like to continue to save as “incomplete.” If you choose to save your claim as incomplete, you must remember to get the correct information and enter it in the incomplete/incorrect claim, and then check the box to make the claim complete before saving. A claim that is not complete results in a score of 0 (zero).
3. Type of Transaction: Defaults to proper setting as Statement of Actual Services..
6. *Select Billing Dentist: This should default from the treating dentist field.
8. Form Version J430D: The specific claim type.
9. **Predetermination / Preauthorization #: If an authorization number is given on the fee ticket, enter it here.
2 Charges Tab
All the following fields are described and need to be completed:
1. ICD: Enter up to four diagnoses beginning in field A.
2. Set Rows: Count how many charges you will post and enter the number here.
3. Procedure Date: Enter the date of service.
4. POS: Defaults to the proper office code.
5. Area of Oral Cavity: Enter if information is provided, but not required on the ADA J430 claim.
6. Tooth System: Defaults to the proper system code JP used for this exercise.
7. Tooth Numbers or Letters: Type or search and select, the tooth number or letter when provided on the superbill.
8. Tooth Surface: Type the surface(s) when provided on the superbill.
9. CDT: Type or search and select, the procedure code as listed on the superbill.
10. Unit Price: Enter the price of the procedure.
11. Units: Enter the number of times this procedure is performed.
12. Description: The description of the procedure will default.
13. Total Charges: The price of the procedure will calculate.
14. Status: Select the option based on whether the insurance payer is electronic or paper.
|3 Additional Info Tab|
1. Missing Teeth Information (Box 33): Click the number of tooth (teeth) missing when provided on the health history form.
2. Remarks(Box 35): Enter any remarks pertinent for the claim to be processed.
3. Print Signature on File in Box 36 and 37: Defaults yes to print signature.
4. Enclosures (Box 39): Indicate whether the patient has enclosures.
5. Orthodontic claim (Box 40): Indicate whether charges are related to orthodontic care.
6. Appliance Placed (Box 41): Enter the date an appliance is placed, if any.
7. Months of Treatment Remaining (Box 42): Indicate how many months remain for patient treatment.
8. Replacement of Prosthesis (Box 43): Indicate whether a procedure was a replacement of prosthesis.
9. Date Prior Placement (Box 44): Provide the date of a prior placement.
10. Treatment Resulting from (Box 45): Click the proper box to indicate whether an injury or accident.
11. Date of Accident (Box 46): Enter the date of accident (Box 46) if box 45 is checked.
12. Auto Accident State (Box 47): Enter the states abbreviation in which the accident occurred.
4 Insurance Tab
This screen provides the opportunity to view and edit any insurance information.
5 Activity Tab
The Activity report lists the activities for all charges on this claim only. This is a good way to confirm postings (both charges and EOBs) and aging.
Save Your WorkAfter completing the 1 Claim tab, 2 Charges tab, and 3 Additional Info tab, it is time to save the claim.