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Note: If there is an alternate name entered into a field in the Provider's User reference, located in Users > Providers Tab > "Name on Line 1 of ADA Box 48 (optional)", that information will pull into Line 1 instead of the Office Name. |
ADA Box 49 - Billing NPI
This field can pull from several different locations:
If the office is billing as a group, the information will pull from the Group National Provider ID (NPI) field in the Office Reference.
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The Group NPI information can be overridden from the Group National Provider ID (NPI) field under the Claim Credentials tab inside the Provider tab within the User Reference.
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If the "Bill as Individual" box is checked under the Provider IDs tab of the Insurance Company Reference, this information will pull from the National Provider ID (NPI) field under the Claim Credentials tab inside the Provider tab within the User Reference.
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ADA Box 50 - Billing License
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Number
This information is populated from the State License field under the Claim Credentials tab inside the Provider tab of the User Reference for the provider.
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ADA Box 51 - SSN or
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TIN
This field pulls from the information entered in the Federal or SSN field found under the Provider Numbers tab of the User Reference.
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The box will have the SSN or TIN number entered, depending on what is selected from the "Provider Tax ID on Claims" pop-up menu found under the Claim Credentials tab inside the Provider tab of the User Reference for the provider.
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This box also populates from the Legacy Type Override pop-up menu under the Provider IDs tab of the Insurance Company Reference.
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ADA Box 52 - Office Phone
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Number
Information is populated from the Phone field in the Office Reference.
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ADA Box 52a - Additional Provider
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ID
Information is pulled from the Provider field under the Provider Numbers tab of the provider's User Reference.
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ADA Box 53 - Treating
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Dentist
This field pulls from the Name Printed in Box 53 of Insurance field under the Provider tab of the User Reference for the provider.
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ADA Box 54 - Treating Dentist
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NPI
Information is populated from the National Provider ID (NPI) field under the Claim Credentials tab inside the Provider tab of User Reference for the provider.
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ADA Box 55 - Treating Dentist License
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Number
This information is populated from the State License field under the Claim Credentials tab inside the Provider tab in the User Reference for the provider.
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ADA Box 56 - Treatment Location
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Address
This field can pull from several different locations: The Office address will pull into this field from the Office Reference if there is not a facility entered in the charge window or a default facility selected in the Office Reference.
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If there is a facility in the charge window, the selected facility's address will be printed from the Facility Reference.
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If there is a default facility entered in the Office Reference, this will override the office address, and the default facility's address will be printed on the claim from the Facility Reference.
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ADA Box 56a - Treatment Provider Specialty
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Code
This box pulls information from the Provider Taxonomy (Specialty Code) field under the Provider tab > Claim Credentials tab in the User Reference for the provider.
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ADA Box 57 - Phone
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Number
Information is populated from the Phone field under the User Information tab of the User Reference for the provider.
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ADA Box 58 - Additional Treatment Provider
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ID
Information pulls into this box from the Paper ID field under the Provider IDs tab of the Insurance Company Reference.
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