For each doctor in your practice or for the facility, you can set up the information to appear on insurance claims for provider services. Click Lists > Employees. The Employee List window is displayed. Click Insurance to access the entry fields.
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Insurance form name Use this field for populating the Name of Billing Dentist or Dental Entity on the ADA-approved dental claim form. If you submit claims under a doctor’s name, enter the doctor’s name, including the DDS. If you submit claims under the name of the practice, enter the practice name.
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Electronic claims file Enter the electronic claims submission ID number assigned by the PracticeWorks electronic claims processing module for an employee.
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Federal tax ID If an employee’s claims are to be submitted under a federal tax identification number instead of a Social Security number, enter the ID number, regardless of whether this employee is a doctor or a facility. This field takes precedence over the Social Security number on the claim form.
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Denti-cal ID If you participate in the California Denti-Cal program, enter the ID number. If not, leave this field blank.
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License number If the employee is a doctor, enter the doctor’s state dental license number. If the employee is a facility, enter the state dental license number under which claims should be submitted for the practice.
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SSN If the employee is a doctor, enter the doctor’s Social Security number. If the employee is a facility, leave this field blank.
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Medicaid number This number prints on the claim form if the employer/plan is set up as a Medicaid plan.
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DEA number If the employee is a doctor, enter the doctor’s DEA number. If the employee is a facility, enter the DEA number under which prescriptions should be prepared for the practice.
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Group number Leave this field blank.
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PIN number Leave this field blank.
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Other Information Use this area to enter specific provider IDs for an employee, as required for state Medicaid insurance forms.