Open Dental Forum

Is OD currently setup for the old or new HCFA 1500 form (latest should be rv. 08/05)?

What works correctly:

Field # > Description
1 > Plan type
2 > Patient name
3 > Patient birthdate
4 > Insured's name
5 > Patient's address
6 > Patient relationship to insured
7 > Insured's address
8 > Patient status
10 > Patient condition related to employment, auto accident, etc
11 > Group #
11a > Insured's DOB and Sex
11b > Employer name
11c > Insurance plan name
11d > Is there another health benefit plan?
12 > Patient's signature
13 > Insured's signature
24a > Dates of service
24b> Place of service
24d > CPT code and modifier
24f > Charges
25 > Federal TIN/EIN
28 > Total charge
33 > Billing provider info and phone #

What doesn't work (unless I'm missing something)

14 > Date of current illness
21 > Diagnosis or nature of illness or injury - also, sometimes there is more than one diagnosis that would be linked to a particular CPT-4 code
24 c > Emergency
24 e > Diagnosis pointer
27 > Accept assignment
32 > Service facility location information
32a > FacilityNPI
33a > Provider NPI
33b > I believe this box is for provider number, eg for BCBS provider number

This is not a high priority item as we can hand write the omitted info for now.

Thank you,

Bill Starck, DDS

It's been working fine for nearly a year. See http://www.open-dent.com/manual/medicalins.html . I just updated that page to include the links in case they are missing from your setup for some reason.

Regarding your specific line numbers:
14 > not automatic
21 > working well
24 c > empty. I don't know what it is.
24 e > working well.
27 > empty
32 > working well
32a > working well
33a > working well
33b > empty

Thanks, that works.

FYI:

24c indicates whether the treatment was related to an emergency
27 indicates whether we are/are not accepting assignment of benefits

Cheers,

Bill Starck, DDS