The Dental Line Item Contract/Date screen includes fields for entering miscellaneous data applicable to particular contract and date information. The Contract/Date fields are defined by section below:
Contract Data: The Contract Data section includes fields for details of the contract between the health care provider and the insurer. Normally this kind of information is not included on a claim, except when the provider is contractually obligated to provide contract information on this claim.
Code identifying a contract type. Options are:
| 01 | Diagnosis Related Group (DRG) |
| 02 | Per Diem |
| 03 | Variable Per Diem |
| 04 | Flat |
| 05 | Capitated |
| 06 | Percent |
| 09 | Other |
Contract amount due for this service line.
Contract allowance or charge percent. Required if the information is different from that given at the claim level.
Term Discount %Term Discount %
Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date. For example, “.05” indicates a 5 percent discount if paid before the due date.
Code identifying the specific contract, established by the payer.
Version IdentifierVersion Identifier
The contract version identifier is the revision level of the contract.
Other Dates: The Other Dates section includes fields for entering miscellaneous dates applicable to a particular service line item.
Prior PlacementPrior Placement
The date of prior placement of the prosthesis, crown, or inlay.
Appliance PlacementAppliance Placement
The date the orthodontic appliances were placed.
Replacement date for appliance or prosthesis.
Treatment StartTreatment Start
Date of the first treatment.
Date of the last treatment.
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