Defining Insurance Claim Field Values

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.

Enter information in the following fields:

Insurance form nameInsurance 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.
Electronic claims fileElectronic claims file Enter the electronic claims submission ID number assigned by the PracticeWorks electronic claims processing module for an employee.
Federal tax IDFederal 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.
Denti-cal IDDenti-cal ID If you participate in the California Denti-Cal program, enter the ID number. If not, leave this field blank.
License numberLicense 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.
SSNSSN If the employee is a doctor, enter the doctor’s Social Security number. If the employee is a facility, leave this field blank.
Medicaid numberMedicaid number This number prints on the claim form if the employer/plan is set up as a Medicaid plan.
DEA numberDEA 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.
Group numberGroup number Leave this field blank.
PIN numberPIN number Leave this field blank.
Other InformationOther Information Use this area to enter specific provider IDs for an employee, as required for state Medicaid insurance forms.