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Many of these fields will pull into CMS/ADA/CDA/UB Claim Forms, or can be added to Paper Forms, EMR/EDR Forms, EHR Forms, and Note Templates.
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Note: The information entered for the Primary and Secondary Guarantor will be the same for all Patients across an account. |
Within the Localization Preference, some offices may have "Use Canadian Claim Fields", this may adjust the name of some fields slightly.
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This information will be pulled into Box 4 and Box 9 (if the Patient has multiple insurance coverages) on the CMS Claim Form,
On the ADA Claim Form, the Guarantor's name will appear in Box 5 (if the Patient has multiple insurance coverages) and Box 12 on the ADA Claim Form.
This will also pull into Part 2 - Your Name Box of the CDA Claim Form and Box 58 on the UB Claim Form.
Many financial items work on an account level, such as statements, and will run based off of the name in the Primary tab. This would apply to things like the Statement Manager and some reports.
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Prefix and Suffix
These fields will be used if the Guarantors happens to have a Prefix or Suffix within their legal name. These fields are both optional.
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The Guarantor's address information will pull into Box 7 on the CMS Claim Form. As well as Box 5 (if the Patient has multiple insurance coverages) and Box 12 on the ADA Claim Form. However, this information does not display on the CDA or UB Claim Forms.
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If the Zip Code exists in the City State Zip Reference, entering the zip onto the Primary/Secondary tab will automatically fill in City and State fields.
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The Country field is designed for addresses outside of The United States. If the address is in the USA, US Territories, or Canada, this box should remain blank. This is especially important when working with eClaims, as incorrect codes will cause a rejection.
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Email Address
This is where the most reliable Email Address to contact the Guarantor should be entered.
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Enter up to three contact numbers per Guarantor. Enter the Phone Number without dashes; MacPractice will auto-format based on the format you have selected Preferences > Localization. For international offices, visit the Localization Preference and Localization Preference and change the Phone Format menu to "International".
Setting up the phone order in the Default Patient record is an important step for an office. The types of numbers can be set to Home Phone, Work Phone, Mobile Phone, or Other Phone.
On the CMS Claim Form, Box 7 will populate with the first listed phone number set to the "Home" phone type.
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This information will pull into Box 11a of the CMS Claim Form and Box 13 of the ADA Claim Form. This will also pull onto Part 2 - Your Date of Birth and Part 3 - Spouse Date of Birth of the CDA Claim Form. (if the Secondary tab is being used) of the CDA Claim Form.
The Guarantor's birthdate does not pull onto the UB Claim Form.
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This information will pull into Box 11a of the CMS Claim Form and Box 14 of the ADA Claim Form. The Guarantor's gender does not pull onto the CDA or UB Claim Forms.
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With Canadian and International claims, the Medicare or ID can be turned on in lieu of the Social Security Number field. Visit the Preferences > Localization > and change the SSN/Medicare drop down menu to your preferred choice.
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Once checked, this information will pull onto Box 12 of the CMS Claim Form, Box 36 of the ADA Claim Form, and Box 52 of the UB Claim Form.
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Signature on File Checkbox
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*Not present with Canadian Claim Fields checked.*
The Signature on File checkbox is the indicator that determines whether insurance benefits are to be received by the Provider or by the Patient. If checked, the benefits will be assigned to the provider. If unchecked, the benefits will be assigned to the patient.
This information will pull into Box 13 of the CMS Claim Form, Box 37 of the ADA Claim Form, and Box 53 of the UB Claim Form.
This field can also be added to a Form/Template in the form of "0" Unchecked and "1" Checked.
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