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cromfs
Premolar II

Delta of California making up their own codes for box 25

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I have box 25 =10 and box 26=JP automatically coded by WinOMS based on entering UR in tooth # field in the treatment plan.  Delta of CA is denying my claim, demanding I enter 'UP' in box 25 for the arch.  This isn't a valid code according to the ADA instruction forms for their form.  I've submitted an appeal but heads up.  There's nothing in the policy manual from Delta about this either.

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CS Dental Employee
CS Dental Employee

Re: Delta of California making up their own codes for box 25

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You are correct, 'UP' is not a valid ADA code.  'UR' was a valid code in the past but that was in an old system which is no longer used. Box 25 is hard coded into CS WinOMS per guidelines provided by the ADA.   If this is actually what Delta Dental of California requires, then Delta Dental will need to provide this in writing so that this change can be made in CS WinOMS.  

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