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wendyrt01
Canine II

Insurance forms & BCBS

I am having problems with BCBS of Tennessee rejecting claims for partials because they need a tooth range.(CDT 2021 is requiring it, so they tell me)  I have documented the missing teeth, the code itself specifies maxillary and mandibular. They will not accept that. There is no way to fix this in Softdent. Box 25 also can not be filled out within the software. I am having to print and mail claims to resolve this. Anyone else having this issue?

5 Replies
bccarestreamrep
CS Dental Employee
CS Dental Employee

Re: Insurance forms & BCBS

The area of oral cavity (box 25) should fill out as follows: 

00 - Entire Oral Cavity
01 - Maxillary Arch
02 - Mandibular Arch
10 - Upper Right Quadrant
20 - Upper Left Quadrant
30 - Lower Left Quadrant
40 - Lower Right Quadrant

However, currently there is no way of specifying a tooth range on a claim form from within SoftDent. If BCBS is needing a tooth range, and SoftDent cannot provide it, you can send us a letter of rejection with that specific reason so that we can make changes to our claim form(s)/software to allow this. 

wendyrt01
Canine II

Re: Insurance forms & BCBS

Should I email this information to someone specific?

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bccarestreamrep
CS Dental Employee
CS Dental Employee

Re: Insurance forms & BCBS

I would suggest calling into support --> 866-435-7473 x2 and letting them know you have a rejection letter from BCBS for SoftDent Escalations to review and get to development so a new insurance form can be created if necessary.

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oneilloffice
Canine II

Re: Insurance forms & BCBS

Hello,

We have Practice works but like the Softdent users claims, BCBS of MA is rejecting our claims for the code D4342 because the oral cavity number is missing from box 25 on the claim. However, the code D4341 the oral cavity number is present so I'm thinking its should not be a complicated fix? 

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bccarestreamrep
CS Dental Employee
CS Dental Employee

Re: Insurance forms & BCBS

I see!

Well, we cannot assist with the ability of setting up a claim to show a tooth range as of now. However with a rejection letter, it's possible this can be allowed in a future release of SoftDent. 

Also, I just tested submitting codes 4341 and 4342 to insurance in SoftDent v19, and box 25 will only be blank if a tooth is specified. If I go to List>ADA Codes and remove the option that reads "Tooth & Surface Required" and select "Quadrant Required," box 25 will show the area of oral cavity when I submit to insurance. If I select a tooth when entering the code in transactions, that box 26 shows information but not 25. If I only select a quadrant, box 25 and 26 show information. Does this help at all?

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