claims basic info

Question 1

Form Type 1:

Answer 1

ADA-Paper- used for smaller insurances such as UHC Dual Complete

Question 2

Form Type 2:

Answer 2

ECS- Electronic Claim

Fillings, 3rds, periodic or comprehensive exams, prophy’s

Question 3

Form Type 3

Answer 3

HLD- Hold- sits in “bin” until you work it.

Question 4

Form Type 4

Answer 4

NEA- needs attachments
crowns, bridge, SRP
PMT do NOT need attachments.

Question 5

Form Type 5:

Answer 5

do NOT use

Question 6

Form Type 6:

Answer 6

Do NOT use

Question 7

Form Type 7:

Answer 7

EUTL: sometimes use- default for simple claims such as just a prophy on Cigna HMO

Question 8

Form 8-10:

Answer 8

Do NOT use

Question 9

SRP needs:

Answer 9

Periodontal charting, FMX/pano (or Bitewings in FMX not within year of DOS)

Question 10

PMT needs:

Answer 10

Periodontal charting, bitewing or FMX/pano x-rays from last 12 months, Periodontal history dates (last 24 months), SRP dates with quadrant info.

Question 11

Build Up Needs:

Answer 11

pre-op x-rays, post-op x-ray, narrative, crown seat date (if available)

Question 12

Root Canal Needs:

Answer 12

pre-op x-ray, post-op x-ray, narrative

Question 13

Crown Needs:

Answer 13

pre-op x-ray, post-op x-ray, narrative, initial placement or replacement date (prior placement date needed if replacement), prep and seat date.

Question 14

Bridge Needs:

Answer 14

date of extracted tooth, list of all missing teeth in arch, pre-op x-ray, post-op x-ray, narrative, initial or replacement (prior placement date needed if replacement)

Question 15

Partial/Denture:

Answer 15

extraction date of teeth, list of all missing teeth, pre-op x-ray, narrative, initial or replacement (prior placement date needed if replacement)

Question 16

Extraction Needs:

Answer 16

pre-op x-ray, narrative

Question 17

3rds Molar Extraction Needs:

Answer 17

panoramic x-ray, narrative

Question 18

IV Sedation/GA Needs:

Answer 18

anesthesia record

Question 19

Biopsy Needs:

Answer 19

typically billed through medical first, pre-op x-ray, narrative, pathology report

Question 20

Occlusal Guard Needs:

Answer 20

FMX/Pano, narrative ( If for HMO plan, include the Referral Form or Auth# If needed by the specific insurance)