This document will go over the fields available under the various tabs within an incident folder. When you select an incident, you will see a number of tabs where you can set additional information about the incident. Generally, the information in these tabs is used on insurance claims printed under that incident. For more information on creating and using incidents, click here.
Incident Tab
The Incident tab will outline the general information about the selected incident. You will need to at least enter an incident name, date and type. If you suspect a claim will be created, you may need to fill out the additional sub-tabs provided within the incident tab.
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 Medication Reconciliation Measure for MIPS.
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 Tab
This Attorney tab allows you to associate an attorney with the incident, and keep track of other information relevant to a legal dispute. This information is for your reference only, and is not used on any forms by default (this information can be added to a custom form/notes, if desired).
In MacPractice MD, DDS, and 20/20, there is a preference that determines whether or not this tab is visible. To enable this, go to the MacPractice menu > Preferences> Ledger > Incident tab > Check the "Show attorneys tab in incidents" checkbox.
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.
Military Tab
*Not present in MacPractice DDS*
The Military tab allows you to enter information related to a patient's military service. This information is for your reference only, and is not used on any forms by default (this information can be added to a custom form, if desired).
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.
Claims Tabs
The Claims tabs will be slightly different, depending on your product (MacPractice MD, DDS, 20/20 or DC) and the preferences that have been selected.
In both MacPractice MD and MacPractice DDS, there is a preference you can enable to see the "CMS Claims" tab and "ADA Claims" tab. Go to the MacPractice menu > Preferences> Ledger > Incident tab > Check the box labeled "Display both CMS and ADA Claim view" to have access to both tabs. You must quit and restart MacPractice in order for this change to take effect.
MacPractice 20/20 and MacPractice DC only have access to the "CMS Claims" tab.
CMS Claims Tab
The information entered into these sub-tabs will be included on the CMS-1500 Claim Form as well as on eClaims.
Symptom Dates 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 Interactive CMS Claim Form.
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 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.
ADA Claims Tab
*Not present in MacPractice 20/20 and MacPractice DC*
The information entered into these fields will be included on the ADA 2019 Claim Form as well as the older ADA 2012 Claim Form.
Box 23B Payment Source Code and Box 25C Locator Code *Not present in MacPractice DDS*
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 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.
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.
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
*Not present in MacPractice DDS*
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.
Prior Authorization Tab
Within this tab, you will be able to enter the prior authorization information in order for it to pull into Box 23 of the CMS Claimform and Box 2 of the ADA Claim Form.
Adding a Prior Authorization
To add a Prior Authorization number to a patient's incident, click the small green plus sign in the upper right corner of the Prior Auth. tab. A new line will be added to the Prior Authorization table. Enter the prior authorization number, select the insurance company associated with the authorization, then enter the total visits authorized, and how many remain. You can also enter an Expiration Date and a Start Date if you wish. The prior authorization will not be used for charges outside of this date range. If you have multiple authorization numbers, simply click the plus button again to add a new line.
To include a prior authorization number on a claim, create a claim as you normally would (click here for more information on claim creation). In the claim creation window, select the prior authorization number you wish to include on the claim from the Prior Auth pop-up menu. The number of remaining visits will be listed in parenthesis after the authorization number.
Each time the authorization number is used on a claim, the Remaining Visits will be decreased by one. If you delete a claim that was associated to a prior authorization, you will be asked if you wish to add a visit back to the prior authorization record. Click Yes to add a visit back to the Remaining Visits; click No to leave the Remaining Visit count as-is.
Resource Tab
The Resource tab allows you to enter information that may be necessary for electronic claims submissions.
Adding a Resource
To add a resource, click the small plus button in the upper right corner of the Resource tab. There are five kinds of resources that can be added: Extraction, Materials Forwarded, Orthodontics, Paperwork, and Prosthesis. Make your selection from the pop-up menu, then click Add.
The selected resource will be added to the Resource table. Click the triangle to the left of it to see your available fields. Each type of resource has different fields available. To enter data in any of the fields, simply select the line item, then press the Tab key on your keyboard twice. This will put your cursor in the Value field, so you can enter the necessary information. Below, each type of resource is listed, followed by the available fields for that resource type. The field names are generally self-explanatory. If you have any questions, please do not hesitate to contact the MacPractice EDI Support Team.
Resource Options
Extraction
Within these fields you will enter the date the tooth was extracted and the tooth number of the extracted teeth.
Extraction Date
Tooth Number
Materials Forwarded
This field will indicate how the information or materials have been forwarded to the payor or clearinghouse.
Materials Forwarded
None
E-Mail
Correspondence
Models
X-Rays
Images
Orthodontics
The fields for this option will be specific to orthodontic work and will add an additional segment to the eClaim based on the information you fill out here.
Anticipated Payment Amount
Diagnostic Phase Fee
Estimated Treatment Start Date
First Examination Fee
Initial Payment
Number of Anticipated Payments
Payment Mode
None
Monthly
Bimonthly
Quarterly
Every four Months
Treatment Duration
Paperwork
These fields are used to indicate to the payor what is being sent to them and how it is being sent. For more information on how to add paperwork to your eClaims, visit our Paperwork documentation.
Attachment Control Number
Attachment Transmission Code
None
Available on Request
By Mail
Electronically Only
E-Mail
By Fax
Attachment Type Code
None
Support Data for Verification
Admission Summary
Prescription
Physician Order
Referral Form
Certification
Dental Models
Diagnostic Report
Discharge SUmmary
Explination of Benifits
Models
Nursing Notes
Operative Notes
Support Data for Claim
Physical Therapy Notes
Prosthetic or Orthotic Certification
Physical Therapy Certification
Radiology Film
Radiology Report
Report of Tests and Analysis Report
Prosthesis
These fields should be used to identify any additional information pertaining to the prosthesis that you would like to add to the eClaim.
Initial Placement Date
Is Initial Placement Checkbox
Prosthesis Material
None
Fixed Bridge (1)
Maryland bridge (2)
Denture (Acrylic) (3)
Denture (Chrome Cobalt) (4)
Implant (Fixed) (5)
Implant (Removable) (6)
Upper/Lower
None
Upper
Lower
