Delta Dental is refusing our submissions for 9944 Occlusal Guard, hard full for lack of information. They would like us to indicate the arch in section 27 of the insurance claim. I have required a quadrant entry for the transaction code using U for upper and L for lower. But these do not print on the insurance claim. How do I get them to print???
Box 27 is designed for the Tooth number or letter. It is not meant for the designation of the quadrant or arch.
The use of that field, as defined by the ADA: Enter the appropriate tooth number or letter when the
procedure directly involves a tooth or range of teeth. Otherwise, leave blank.
Box 25, however, is designated for that information. Titled "25. Area of Oral Cavity"
The use of Box 25, as defined by the ADA: Use of this field is conditional. Always report the area of the oral cavity when the procedure reported in Item #29 (Procedure Code) refers to a quadrant or arch and the area of the oral cavity is not uniquely defined by the procedure’s nomenclature.
As it is, there is not a way to make the arch/quadrant show in box 27. using U or L for upper/lower should show an entry in box 25 however as 01 for Upper (Maxillary) or 02 for lower (Mandibular) areas.
If a particular insurance requires something different then standard, we would want to see that in writing so it can be submitted as a change needed to development.
Thank you for the clarification, but in Practice Works I do not see where I can add this information to box #25. I have looked at the Insurance Submittal Information Window and the Submission details window and I am not able to find the location to put this information in. Please advise.
Box 25 would be filled in as long as a quadrant or area is entered in with the code.
For example "9944 U" on the ledger would automatically fill in box 25 with 01
These are the codes that will enter in box 25
00 - Whole of the oral cavity
01- Maxillary area
02 - Mandibular area
10 - Upper Right Quadrant
20 - Upper Left Quadrant
30 - Lower Left Quadrant
40 - Lower Right Quadrant
PracticeWorks will recognize and convert multiple ways of entering a quadrant or area.
for example 01 "Maxillary Area" can be entered as:
Any one of these would be seen as correct in the software, and print out the 01 in box 25 on the claim.
Upper Left or Upper Right can be also as "UL" or "UR" and so forth for other areas.
As long as the code itself is set so that quadrants are either optional, or required, it will allow, use, and 'print' out the correct claim designation codes.
I was advised by a Delta Dental of CA representative to use UP for maxillary. I had previously used 01 and U but the claims were denied. The claim was processed using UP.