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Canine II

Setting up Treating Dentist, Group Info Box 48 Box 53

Our software was set up before my time.  Over the years we have had some issues with box 48 & box 53, but for the most part no issues.

Recently, we had claims initially sent electronically that needed to be corrected,  printed to paper & sent to the payor for correction. They were returned because the "treating dentist" was not listed in box 53,  the group was.   I called the Clearing House(ClaimX) first and was told the treating dentist was listed correctly in box 53 on their end-so the issue occurred when it was printed to paper.  I made a call to Practice works and they pulled up the doctor from the employee field and it was listed as the group name instead & he fixed that. What I don't understand is how they are going out correctly electronically and not on paper?

Another issue is that  some of the claims were printing with the Group info in box 48 yet some with the Treating dentist. Even when it lists the group, the  correct NPI was not attached and the treating dentist license number was populating.  We bill as a group & get paid as a group.  Support was able to offer a fix for that by creating an employee named "group" , selecting that in a drop down menu and we tested it.  Before this change was made, since some claims were printing with the group without having to do this step, so is there another area that defaults from besides the employee menu?

CS Dental Employee
CS Dental Employee

The only thing that come from outside the employee settings is what you want printed on the Dr's signature line of the claim form. This is something that can be set in the "Configuration of PracticeWorks" General configuration. Is it possible that you are using different insurance forms? It is very common in PW to have different insurance companies tied to different forms. There is a patch in the utilities that will allow you change the insurance forms.