When an explanation of benefits (EOB) is received for an insurance claim, the basic routine below can help you complete the necessary processing steps:
1. Post the insurance payment to the Ledger (If no payment was made, enter a 0.00 payment if there is a legitimate reason; this flags the claim as "Received.")
2. If the actual payment is different than the estimate, and will always be different, update the insurance payment table in the Ledger window when entering a dental insurance payment that is itemized.
3. Enter any deductible amount applied for a dental claim while entering the payment.
4. If an explanation of benefits gives reason to re-send a claim, split the primary claim, post multiple payments, and update the claim status in the Ledger, then re-send the procedures that need further documentation.
5. If a payment is received on a primary claim for a patient with secondary insurance, create and send the secondary pre-authorization to the Batch Processor.
6. When an explanation of benefits is received for a pre-treatment estimate claim, enter the pre-authorized amount and flag "Accepted" or "Rejected" for each procedure in the Ledger.
7. When entering a pre-authorized amount, if the amount is different than the estimate (and is not unique to this patient), update the Insurance Payment Table in the Ledger window .
Note: You may also want to verify that the coverage table is correct.
8. If authorization is received for primary insurance, create and send the secondary pre-authorization estimate to the Batch Processor.
9. Post any guarantor payments in the Ledger received through the mail.
10. Use the Batch Insurance Claim option in the Office Manager to create claims for the day (if not already created through the Ledger). Print (or send electronically) all insurance claims and pre-treatment estimate claims for the day listed in the Batch Processor in the Office Manager.