EZ 2000 Manual - Claim, General Tab

Claim - General Tab

The General tab on the Edit Claim window has many fields that are used rarely and are for special insurance situations.

Crown, Bridge or Denture: For bridges, dentures, and partials, Missing Teeth must have been correctly entered in the Chart module.

Place of Service: Indicates the service location type. Usually set to Office, except for certain procedures to specific insurance carriers (e.g. Medicaid) or sometimes when using Clinics. Changing this value on the claim will cause the Place of Service values on all of the claim procedures to change as well. This value is sent on E-Claims.

Accident: Used to indicate that dental treatment was needed as the result of an accident.
- Accident Related:  The type of accident.  Shows on printed claims in the following fields (depending on the value chosen): IsOccupational, IsNotOccupational, IsAutoAccident, IsNotAutoAccident, IsOtherAccident, IsNotOtherAccident, IsNotAccident, IsAccident, MedAccidentCode.
- Accident Date:  Shows on printed claims and E-Claims.  On printed claims, shows in the AccidentDate field.
- Accident State:  Shows on printed claims in the AccidentST field and on e-claims for auto accidents.

Ortho: Only used for Orthodontic claims.
Is for Ortho: This checkbox affects the IsOrtho and IsNotOrtho fields on printed claims. If the checkbox is marked, then Months Remaining is reported on E-Claims (in Canada the ortho flag is sent electronically instead).
- Months Remaining:  Shows on printed claims in the MonthsOrthoRemaining field if the value is greater than zero.
- Date of Placement:  Shows on printed claims and dental e-claims.  On printed claims, shows in the DateOrthoPlaced field.

Claim Referral: Only enter a referring provider and referral number if it is required by your insurance carrier.
- Referring Provider: Click select to attach a referring provider from an existing list, or add a new Referral. Click None to clear the field. Click Edit to enter notes or change information about the selected provider.
- Referral Number: Provided by your insurance carrier. Do not put NPI numbers here; NPI numbers must be entered on the Edit Referral window. If an NPI number is missing, it will cause a claim rejection.

Claim Note: Shows on printed claims and E-Claims. This note is a claim level note. There is also a procedure level note which only goes out on e-claims. There is no place on a printed claim form to put a procedure level note. A procedure level note is added in the Procedure Edit window.

Attachments:  Document which attachments will be sent with the claim and how they will be sent. For Radiographs, Oral Images and Models, enter how many pages will be sent for each. On paper claims, only the fields for Radiographs, Oral Images, and Models will show. On E-Claims, all fields will show.
- By Mail/Electronically: Select how the attachments will be sent.
- Attachment ID: If you are sending electronically and have been given an attachment ID (e.g. NEA#), copy it, then paste it here.  The ID will be prepended to the notes field and will also go out on the e-claim in a special field for attachments. 

The attachments themselves are NOT sent by EZ; you must send them separately using a service such as NEA.  See Electronic Attachments.

Attached Images: Select which images will be sent as attachments, then export them to a temporary folder. This does not send the images electronically; you must manually import the images from the temporary folder to NEA.  See Electronic Attachments.
- Add: Select an image from the Images module.
- Perio: Attach the current Perio chart including up to 5 historical measurements.
- Export: Export all selected attachments to the folder defined in Account Module Setup, "Claim Attachment Export Path".
Double click on any attachment to view the image. Right click to open, rename, or remove.