Service Line(s)

A Service Line is listed on a claim for each procedure or item that is to be reported to the Payer(s) for claim adjudication. Each claim must contain at least one Service Line.

The main view of the Service Line(s) tab contains the basic information for the line as it relates to NY Medicaid. Additional information and adjudication details from Other Payers are available on subsequent pages. As a default, 5 Service Lines are displayed on the main page, however you may add as many as needed, up to a maximum of 50, simply by clicking Add More Service Lines. You may remove any single Service Line by clicking the Remove icon on that line. In addition, the total of all the submitted charges for the Service Lines is listed below all the Service Lines that have been entered.

Ln (Line): This is a system generated value to uniquely identify the Service Line on the claim. The counter will start with 1 and increment with each new Service Line entered. A minimum of 1 Service Line is required on all claims.

Line Item Ctl#: This field can be used to enter a line number that corresponds with your records if it is different than the line number given.  This field is not required.

Date of Service (DOS): The date on which the service was rendered. The date may not be greater than the current date. The format is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field. When finding this claim on the Find Claims page, the Begin Date corresponds to the Date of Service on Line 1 of this claim.

ADA Code: An American Dental Association (ADA) Procedure Code is required on all Service Lines.

Proc. Count:  The number of procedures associated with the Service Line, required when an ADA Code is entered.

Oral Cavity Area: Enter the 2-digit code to identify the area of the oral cavity if the procedure billed requires quadrant or arch identification. Additional codes may be entered by clicking the More icon.

Tooth Num: Enter the tooth identification (or choose from the drop down box) if the procedure being billed requires tooth identification. If multiple teeth are affected by the procedure, additional Tooth Numbers may be entered by clicking the More icon. A Tooth Number may not be repeated on a single service line.

Tooth Surface Codes: Select the boxes for the corresponding surfaces that were affected by the procedure. A maximum of 5 surfaces may be selected. "I" and "O" may not be selected at the same time; and "B" and "F" may not be selected at the same time.

Amt Chrg: The submitted charge amount for this procedure/service must be entered. Note: Zero dollars is a valid charge amount.

Total Claim Charges: At the bottom of the table of Service Lines, all charges for all Service Lines on the claim will be summed and displayed, once the Service Line Information is saved.

For each Service Line, you may view/enter additional details by clicking the More icon. However you may only view these additional details once all required elements have been entered. Navigating off this summary page, either by clicking the More icon or moving to another tab, will trigger validation of the data entered on this page. Validation is done one line at a time, so if there are errors on multiple lines you will have to fix each line before seeing the next set of errors. If a Service Line must be removed for any reason, clicking the Delete icon will remove the line and re-sequence the remaining Service Lines.

Click here for the controls located at the bottom of the page.