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cromfs
Premolar II

Claim with more than one page

Is there a setting to keeping all but the last page from printing total on line 32 on the ADA form and the equivalent on the CMS 1500?  Printing the total on the other pages causes the insurance companies to break the claim into multiple claims which causes unnecessary denials, and rejections for totals being out of sync in the case of BCBS medical.  I just had an Assurant claim break into 2 and because the 2nd page/claim only had anesthesia charges, they denied it because there were no surgery codes on the claim and also denied as duplicate charges for the addtional D9223s.

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joshua_h
Canine II

Re: Claim with more than one page

Hi there, Tara. The ADA claim form always totals the fees by page, rather than the overall total for the entire claim. I believe this is due to ADA guidelines for box 32 (total fee):

http://www.ada.org/~/media/ADA/Member%20Center/FIles/ada_dental_claim_form_completion_instructions_2... 

For the CMS 1500 forms, by default they should calculate the total for the overall claim instead of calculating it by page. If the claims in your system are showing the total by page, you may have a custom insurance form set up in Forms Designer. You can check to see if you have any custom forms created by going to the Utilities menu, then to Forms Designer. 

Let me know if you have any further questions!

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cromfs
Premolar II

Re: Claim with more than one page

I have a hard time believing this is the rule since the insurances are consistently breaking the claims out into separate pages when submitted electronically.  I also had Delta Dental of Colorado get snippy with me because they said the claim was broken out since we totaled it on each page-again-electronically so I have no control over it-I'd have to submit everything by paper then white out the total on all pages but the final one.

The instructions from the ADA link provided say:

"NOTE: Items 24 through 31, following, apply to each of the 10 available lines on the claim form for reporting dental procedures provided to the patient. The remaining Items in this section of the form (33-35) do not repeat."

This skips line 32 so it's unclear whether to repeat it or not.  But then later on it says:

"(Note: Item 31 above is the last of the repeating ‘service line’ items.)

31a Other Fee(s): When other charges applicable to dental services provided must be reported, enter the amount here. Charges may include state tax and other charges imposed by regulatory bodies.

32. Total Fee: The sum of all fees from lines in Item #31, plus any fee(s) entered in Item #31a."

To me this means 32 should not be repeated.

cromfs
Premolar II

Re: Claim with more than one page

Is there a way to call ADA to get clarification?  If it should indeed be repeated then we have a bunch of insurances that aren't following the guidelines.

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cromfs
Premolar II

Re: Claim with more than one page

I just checked and we don't have any custom design forms so therefore it's totaling on the regular CMS 1500 by page.

Community Manager
Community Manager

Re: Claim with more than one page

joshua_h‌ or matt.ackerman any further input on this? 

cromfs
Premolar II

Re: Claim with more than one page

Hi Matt,

As I said above, it actually isn't clear that those are the ADA guidelines.  It actually indicates it shouldn't total by page since items to repeat end at line 31.  Also I previously indicated we don't have any custom claim forms.

Too many insurances are breaking up the claims into separate claims by page for me to believe the ADA guidelines are to total by page.

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CS Dental Employee
CS Dental Employee

Re: Claim with more than one page

cromfs‌ i have read through the instructions that joshua_h‌ provided from the ADA on completing the dental claim form (2012) and also a few other interpretations of those instructions on different carriers' websites.  The only recommendation I found on how to deal with the additional pages was to handwrite "X of Y pages" on the top right of each form.

That's it.

Isn't it strange that there is no other instruction on how to handle this anywhere on the internet?

Your suggestion to contact the ADA and find out what they recommend probably doesn't help us in the short term -- it won't change how the insurance companies are actually interpreting and implementing the instructions. Speaking directly to the people at the insurance company who are responsible for adjudicating the claim may provide the best answer.

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cromfs
Premolar II

Re: Claim with more than one page

Unfortunately we need to have the resolution automated.  I can't start printing all of my claims and mark X or Y and forego using eClaims that we are paying for and also have to pay for stamps and printer paper.  I think Carestream should create a custom form for now that we test out using.  If more claims start rejecting for not having the total than those that are rejecting for having the total, then we will know it's these individual insurance companies' misinterpretation of the ADA guidelines for the claim form and then I can start contacting them-there are a lot.  I am experiencing the same thing consistently with BCBS medical also though on the CMS 1500-also not a custom form.

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njokuc
Canine III

Re: Claim with more than one page

Hi Tara,

Like Josh mentioned earlier, you can create a forms designer rule for your paper HCFA 1500 forms to total by page. However this option is not available for paper ADA forms. The only way at this time to total by page for ADA forms is to break your claim manually into multiple claims which I can agree is a time consuming processes. The best alternative would be to mark the claims page 1 and page 2 as Matt suggested earlier. An enhancement request will be created to allow the use of Form Designer to total by page just like HCFA form 

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