Incident Date/Time

The Incident Date will default to the day the incident was created, but it can be manually overridden. Additionally, there is a preference to automatically set the Incident Date to the Procedure Date of the first procedure entered in the incident. This preference can be found within the MacPractice menu > Preferences > Ledger > Incident tab > Check "Set incident date to the date of the first transaction".

Incident Name

The Incident Name can be whatever you like. The name and date will be displayed in the Incident menus throughout MacPractice, so it should give you an idea of the purpose of the incident. Common incident names include the year (for offices who use one incident per year), or the reason for the patient's visit. You can set the incident name that will be assigned to new incidents by default in the Incidents tab of the Ledger preferences.

You can search for and create a new incident name by entering it in the Incident Name text menu. You can also go to References > Incident Name to manage the existing names and create new ones.

Incident Type

The Incident Types are used to identify the type of procedures that are being included in the selected incident. For example you may have a "Routine Visit", "Surgery" or "Consultation". In some areas of MacPractice, such as the Claim Manager allows you to filter by an Incident Type as well. 

You can search for and create a new type by entering it in the Incident Type text menu. You can also go to References > Incident Type to manage the existing types and create new ones.

Referral

The Referral field allows you to enter a referral for the incident. The referral entered in the incident will be pulled into the New Charge window automatically, when charges are entered under the selected incident. If the referral is not listed on the incident, it must be added manually to each charge.

If the referral is listed on the charge, the information will be printed in Boxes 17, 17a, and 17b on the CMS Claim Form.

First Encounter Checkbox

If this was the first time that the patient was seen in the office, be sure to check the box notating that this was the First Encounter.

This is also a necessary step to add patients to the Denominator of the /wiki/spaces/MPHelpDesk/pages/86245395 for MIPS attestation.

Box 19 on CMS-1500 Claim Form Field

Text entered in the "Box 19 on Insurance Form" field will be printed in Box 19 of the CMS Claim Form.

Facility Tab

The Facility field allows you to select a facility that will be used in the new charge window when you select a Place of Service other than "Office".  If the facility is not listed on the incident, it must be added manually to each charge.

Once this information is filled out, it will pull into Box 18 on the CMS Claim Form, or Box 56 on the ADA Claim Form. 

You may also choose to have the facility pull to all charges entered in the incident, regardless of place of service. To enable this preference, go to the MacPractice menu > Preferences > Ledger > New Charge tab > Check the box labeled "Always pull facility from incident".

Facility/Facility ID Display

Once a facility has been selected, it will be displayed here to ensures that all of the relevant information for the Facility will pull into the claims appropriately.

The information on an existing facility may be edited by double clicking on the name of a Facility inside the selector window and unlocking the record. You can also add a new facility by clicking the green plus in the Facility selector window. Creating or editing a Facility here is the same as adding/editing in the Facility Reference.

Admission Source/Type

The options selected in the Admission Source and Admission Type fields will generate a numeric code based on the selection you made and add it to the claim if necessary. 

Admitted Date/Time 

*Not present in MacPractice DDS*

Within these fields, you will enter the date and time the patient was admitted.

Discharge Date/Time

*Not present in MacPractice DDS*

Within these fields, you will enter the date and time the patient was discharged.

Reason For Treatment Tab

The Reason for Treatment area determines what is populated in Boxes 40, 45, 46 and 47 of the ADA Claim Form, and Boxes 10a, 10b, 10c , and 14 on the CMS 1500 Claim Form.

Condition Related To

Select the closest available option here relating to the condition you are treating the patient for. 

When "Auto Accident" or "Other Accident" is selected within the Condition Related To menu, the corresponding box checked in Box 45 on the ADA Claim Form and Part 3 (Section 3) on the CDA Claim Form.

Based on the selection in the Condition Related To menu, either Boxes 10a, 10b, or 10c on the CMS Claim Form will be checked.

Accident Date

Here you will add the date of the accident or treatment. Some "Condition Related To" options will require a date and will show red text when required.

The date entered in this box will pull into Box 46 on the ADA Claim Form and Box 14 on the CMS Claim Form when an injury is selected as the "Condition Related To".

Accident State

Select the state the accident occurred here. This is also a required field for some "Condition Related To" and will show red text when required. 

The state selected in this menu will populate into Box 47 on the ADA Claim Form and Box 10b on the CMS Claim Form.

Occupational Illness/Injury Checkbox

When checked, the "Occupational Illness/Injury" will be checked in Box 45 on the ADA Claim Form.

This checkbox is available in MacPractice MD, DC, and 20/20, but it does not pull onto claim forms. 

Prosthesis Checkbox

When checked in the Incident, "Yes" will be checked in box Box 43 on the ADA Claim form. 

This checkbox is available in MacPractice MD, DC, and 20/20, but it does not pull onto claim forms. 

Orthodontics Checkbox

*Not present in MacPractice MD, DC or 20/20*

When checked in the Incident, "Yes" will be checked in box  Box 40 on the ADA Claim form and Part 3 (Section 5) of the CDA Claim form.

Initial Placement Checkbox

*Not present in MacPractice MD, DC or 20/20*

When the Initial Placement box is checked, the claim will consequently have the "Yes" box checked in Box 43 on the ADA Claim Form and Part 3 (section 4) of the CDA Claim form. 

Attorney Name Display

Once an Attorney has been selected, it will be displayed here to ensures that all of the relevant information for that Attorney is correct.

The information on an existing attorney may be edited by double clicking on the name of the Attorney inside the selector window and unlocking the record. You can also add a new attorney by clicking the green plus in the selector window. Creating or editing an attorney here is the same as adding/editing in the Attorney Reference.

Notes

This field can be used to add any additional notes relevant to a legal dispute. This field is only for your reference, and is not tracked on any reports within MacPractice.

Report Sent Date

This field can be used to add the date the report was sent to the Attorney regarding the legal dispute. This field is only for your reference, and is not tracked on any reports within MacPractice.

Deposition Date

This field can be used to add the date of the deposition regarding the legal dispute. This field is only for your reference, and is not tracked on any reports within MacPractice.

Hearing/Trial Date

This field can be used for your reference to keep track of the date of the hearing/trial. This information is not tracked on any reports within MacPractice. 

Notice of Firing Checkbox

This is a simple checkbox for you to reference and keep track of if the patient was given a notice of firing due to the legal dispute. This information is not tracked on any reports within MacPractice. 

Final Settlement

This is another date field where you can add the date of the final settlement on the case this incident pertains to. This field is also for your reference only, and is not tracked on any reports within MacPractice.

Effective Date

This date field can be used to note the effective date of the patient's military service. You could also use it to note the effective date of the illness or injury this incident is covering. 

Branch

This menu will list the 5 military branches as well as "Public Health Service" and "CHAMP/VA" for you to select. 

• 0 - None

• 1 - Army

• 2 - Air Force

• 3 - Marines

• 4 - Navy

• 5 - Coast Guard

• 6 - Public Health Services

• 7 - CHAMP/VA

When the Military Branch pull field is added to a form/note, it will displays a number 0-7 representing the branch selected within the incident.

Termination Date

This date field can be used to note the date the patient was discharged from the military or active duty. This date could also be used for the date they were released from their medical waver.

Status

The Status menu includes three options:

• 0 - None

• 1 - Social Security Number

• 2 - Federal ID

• 3 - Both

When the Military Status pull field is added to a form/note, it will displays a number 0-3 representing the status selected within the incident.

Date

Eligibility

The Eligibility menu allows you to indicate how insurance eligibility was verified. The options are:

• 0 - None

• 1 - Insurance Phone Call

• 2 - Employer Phone Call

• 3 - Payor Card Presented

• 4 - Signed Statement

When the Military Eligibility pull field is added to a form/note, it will displays a number 0-4 representing the option selected within the incident.

Symptom Dates Sub-Tab

The Symptom Date area determines what is populated in Box 14 and Box 15 on the CMS 1500 Claim Form. For more information on these fields, please see our CMS 1500 (02/12) Form At A Glance article.  

First Symptom Date and Type

The First Symptom Date field will be used to add the date the patient began seeing symptoms of their illness/pregnancy/etc. Also, use the First Symptom Type menu to select the type of symptom the patient is experiencing. A qualifier may be added to Box 14 based on your selection.

• None

• Routine Services

• Illness

• Last Menstrual Period

Once added, these will show in Box 14 of the CMS Claim Form.

Other Date and Type

A First Symptom Date and First Symptom Date Type other than "Routine Services" must be present before the Other Date will pull into Box 15 on the CMS Claim Form.

First Consultation and Last Seen

Enter the patient's Initial Treatment date in the First Consultation date field in order for this date to be accurately reported for eClaims. The Last Seen date will also only be sent on eClaims.

Assumed and Relinquished

These fields are only used on eClaims in the event one provider assumes care from another provider for a patient.

Disability Sub-Tab

These fields are typically only used for Workman's Comp claims to identify the patient's disability information. For more information on creating visit our Creating Worker's Comp Paper Claims in MacPractice or Worker's Compensation eClaims articles.

Partial/Total Disability Begin/End Date

his will pull into the claim to inform the insurance company of the dates the employee is unable to work. This corresponds with Box 16 on the CMS Claim Form.

Last Work Date

This will pull into the claim to inform the insurance company of the date the employee last worked.

Return to Work

This field is available for your reference only, and does not pull onto any forms/notes by default. However, it can be added to custom forms/notes if desired.

Other Claim Data Tab

Box 11B Qualifier and Other Claim ID

This field will allow you to add the other claim ID (often the WC claim number assigned by the payer) and qualifier codes (Designated by NUCC) to Box 11b on the CMS Claim Form.

Box 10D Claim Codes

If the patient has Medicare as a primary and Medicaid as a secondary, this box should be filled with MCD and their subscriber ID. This information will pull into Box 10d on the CMS Claim Form. 

Box 23B Payment Source Code and Box 25C Locator Code

These fields are generally left bank and do not pull onto the CMS Claim Forms by default. It is primarily used on the New York State Medicaid 150003 form. However, we can certainly customize a form/note to pull the information from these fields. 

Box 39 Number of Enclosures (00 to 99)

Within these three boxes, you will want to enter the number of enclosed attachments. This information will pull into Box 39 of the ADA Claim Form.

• Radiograph(s)

• Oral Image(s)

• Model(s)

Box 41 Date Appliance Placed

Use this date field to indicate the date an orthodontic appliance was placed. As it says above, the date will pull into Box 41 on the ADA Claim Form. 

Box 42 Months of Treatment Remaining

 Enter the remaining number of months required to complete the orthodontic treatment. This number will pull into Box 42 on the ADA Claim Form. 

Box 44 Date Prior Placement

The date of the previous placement will need to be entered here, if the patient previously had these teeth replaced by a crown, or a fixed or removable prosthesis, or the claim is to replace an existing crown. The date will pull into Box 44 on the ADA Claim Form.

Total Months of Treatment

Enter the total number of months required to complete the orthodontic treatment. This is for your reference, and does not pull onto any forms/reports. 

Box 23B Payment Source Code and Box 25C Locator Code

As above, in the CMS Claim tab, these fields are generally left bank and do not pull onto the ADA Claim Forms by default. It is primarily used on the New York State Medicaid 150003 form. However, we can certainly customize a form/note to pull the information from these fields.