Ask Support or your Implementation Manager to activate the Internal Setting(s).
Dental Setup
Dental Payer
- On the Insurance in the Insurance Library, select Electronic/Dental for the Primary Form Type.
ANSI 5010 Dental Segments
Loop 2300 Claim Level
CLM*432E82**150***11::1*Y*A*Y*Y*B
DTP*472 (Service Date)
DTP*452 (Appliance Placement)
DN1 (Ortho Months of Treatment)
DN2 (Tooth Status)
HI*ABK:Z0120
Loop 2400 Line Level
LX*1
SV3*AD:D1110:TH*150*11********1
TOO (Tooth Information)
DTP*441 (Prior Placement)
DTP*452 (Appliance Placement)
DTP*446 (Replacement)
DTP*196 (Treatment Start)
DTP*198 (Treatment End)
REF*6R*432E82L1
Modifiers/Tooth Identifier/Surface/Quadrant
Dental Modifiers can be 1 to 8 characters.
- The Tooth Identifier, Surface Codes, and Quadrant Codes must be added to the Modifier Library.
- In Charge entry, the Modifiers will not auto advance to the next Modifier field on databases where Dental has been activated.
- Tab to the next Modifier fields.
- Tooth Identifier: The Tooth Identifier is added in the Modifier 1 field.
- Surface Codes: These must be ANSI Codes. The Surface Codes identify the area of the tooth that was treated.
- B: Buccal
- D: Distal
- F: Facial
- I: Incisal
- L: Lingual
- M: Mesial
- O: Occlusal
- These are added in the Modifier field.
- If more than 1 Surface Code, add as an additional Modifier.
- Quadrant Codes: The Quadrant Codes will be used in the Modifier field. A Quadrant is defined as four or more contiguous teeth and/or teeth spaces distal to the midline.
- The Code starts with a 2-digit ANSI code that designates the area of the oral cavity: 00, 01, 02, 10, 20, 30, or 40.
- It ends with .Q
- 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
Add Taxonomy Code to Box 56A
If the Payer wants a Taxonomy Code on the Claim, ask Support or your Implementation Manager to add the Cross Code to put the Taxonomy Code on the Claim.
- Individual Taxonomy code for Dental
- Pay To/Billing Group Taxonomy for Dental
Instructions on completing the 2019 ADA form (external link): ADA Dental Claim Form