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Need help to understand how to fill the health form
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Hi,
Need help to understand how to fill the health form for D4260(41874) and D4263(21210) and D7210 if there are all 4 qts. treatments and multiple extractions involved how to enter the information on section 24, thank you.
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Hi Guest! No problem. In the "supplemental information" area of the line item (the red shaded line that is typically left blank), there are special qualifiers you can enter to indicate tooth numbers, areas of the oral cavity, and/or short narrative descriptions. JP is for tooth numbers JO is for areas of the oral cavity ZZ is for short narrative description For example, for extractions, you can enter "JP" followed by the tooth numbers. For areas of the oral cavity, you would enter "JO" followed by the following numbers that represent areas of the oral cavity: 10 : Upper right quadrant 20 : Upper left quadrant 30 : Lower left quadrant 40: Lower right quadrant Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46-48: https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2020_07-v8.pdfHope this helps!
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Rank: Guest
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Rank: Guest
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Thank you a lot, really appreciate your help and guidance.
1)I would also like to know that what need to do for the pre estimation or pre-approval, besides leaving the DOS area blank anything else need to do?
2)I'm also confused with the 24-F charges as do I need to enter the fees for the one D7210 or need to add the total for the multiple D7210 in 24-F. I'm very clear that in total charges we are entering the total from 1-6 lines.
Thank you
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 17,236
Was thanked: 16 time(s) in 15 post(s)
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Rank: Administration
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Hi Guest!
So, leaving the dates of service blank on the claim form is one way to do it. However, heads up - that is not "the norm" for medical insurance like it is for dental. Of course, dental claims have a box to check to say it is for a pre-auth/pre-d, but most medical pre-auth requests are not submitted in the form of a claim! Some medical insurers have their own specific form you can fill out (many times available to print or download on their website), some will just have you submit it in the form of a letter request.
As for the charges in field 24f - that should be the total for that line item. So, if you are billing for 1 unit of something that costs $100, the fee for that line item will be listed as $100. If you are billing for 2 units of something that costs $100, it should be listed as $200 for that line item, and so on.
Hope this helps!
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Rank: Guest
Joined: 9/8/2012(UTC)
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Definitely, this helps, thank you!
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Nierman Practice Management Forum
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DentalWriter
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Need help to understand how to fill the health form
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