Required Fields for the OrthoTrac Electronic Claim Service

Window Name

Required Fields

Patient Information (Patient Chart)

• Name

• Address

• Birthday

• Sex

• Start Date

See Adding Patient Information for more information.

Responsible Party Information

• Name

• Address

• Birth Date

• Insured ID or Social Security Number

• Relationship

• Insurance Carrier

See Adding Responsible Party Information for more information.

Staff Maintenance

• Dr. Name

• Phone

• Address

• Social Security Number or Tax Identification Number

• License

• Provider #

• ECS Location (assigned by Carestream Dental Electronic Services)

• If Applicable: Medicaid #, BC/BS #, Delta #, Association #

See Adding Staff Members for more information.

Location Maintenance

• Practice Name

• Phone Number

• Street Address

• City, State, Zip Code

• Social Security Number or Tax Identification Number

See Adding Locations for more information.

Insurance Carrier Information

• Carrier Information section — Name, Address (City, State, and Zip), Release, Assign

• Employer Information section — Employer Name, Policy Number (Group ID)

• Claim Processing section — Process Claim (electronic), Payer, Claims Office, Continuation of Treatment, Claims Office, Continuation of Treatment Override (if applicable)

See Setting Up Carriers for more information.

Procedure Code Maintenance

• ADA Code

• Insurance Amount

• Insurance Description

See Setting Up Procedures for more information.

Insurance Claim Options

• Social Security Number or Tax Identification Number

• Monthly Comment

• ADA Code for Continuation of Treatment

See Setting Up Insurance Claim Options for more information.