Adding Forms, IDs, and Notes

Use the Forms/IDs/Note tab (Tables > Insurance > Plans) to provide detailed information about insurance forms, group and provider IDs, and electronic claims setup information for the selected Insurance Plan.

To add Form, ID, and Note information:

In the Insurance Form Options section, set the following options:

Form #Form # Applies an insurance format based on the selected insurance coverage: medical or dental.
This field should be left blank if the plan is a capitation plan. If a form needs to be printed for a capitation plan, contact your Carestream Dental representative for assistance.

UB-92 Form #UB-92 Form # Applies an applicable UB-92 format if the plan accepts UB-92 billing. Leave this field blank if the plan does not accept UB-92 billing.
Primary Ins Proc MethodPrimary Ins Proc Method Indicates how to process the claim. Select Paper or Electronic.
Procedure to PrintProcedure to Print Sets a coding method.
Diagnosis MethodDiagnosis Method Sets the method to print reference numbers or codes. Select 1 to print reference numbers or 2 to print ICD-10 codes in HCFA box 24E. Select 3 to include no diagnosis codes or pointers on claims for this plan.
NOTE: Value 3 does not apply to UB04 forms.
POS MethodPOS Method Sets the method to print service codes. Select 1 to print single-digit place-of-service codes or 2 to print double-digit place-of-service codes.

In the CLIA Filing field, select Provider, Office, or Practice, or leave at 0.
In the Anesthesia Units field, set to As Units, or To Minutes, based on the plan's billing requirements for drugs used for anesthesia.
For ADA paper forms 110 and 111, the Quadrant Values field is active. The default is Numeric. Change this to Alpha for insurance plans that require alpha characters for quadrant values.
Select the Prefix CDT Codes with "D" option to have the software replace the leading zero of your dental codes with a D on insurance claims for that particular plan.
Dental codes posted using leading zeros instead of a D will continue to display the leading zero in the ledger.

Select the Print Dental Codes on Med. Forms option to include dental procedures on medical claim forms for this plan.
Select print options from the following lists:

HCFA Plan Code
HCFA Box 19
HCFA Box 24J
HCFA Box 33a
HCFA Box 33b

These options are for medical forms only.

If you use the WinOMS electronic claim processing service, complete the fields in the NEIC Setup section:

In the Payor ID field, type a payor identification number.
In the Payor SubID fields, type a payor sub-identification number provided by NEIC.
From the Payment Source drop-down list, select a payment method.

To automatically display a note when scheduling a patient who has a policy that uses the insurance plan, select Alert When Scheduling and type a note in the space provided.
In the Group ID and Medigap ID Number fields, type a group and Medigap identification number, if applicable.
If you do not need to enter individual provider IDs, go to Step 13.

To enter individual provider IDs, click New. The New Provider/Office/Plan ID window is displayed.

Select Plan ID or EMC ID.
Use EMC ID only for carriers requiring it. This option requires the EMC provider ID to appear in BAO, YA0 and BA1.

Set the following options:

ProviderProvider Name of the individual provider of services
OfficeOffice Office where the provider performs services
IDID Identification number

Click Save.