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Posting insurance payments
When you post insurance payments, you can either post the total payment amount or itemize the payment. If the insurance carrier does not present you with an Explanation of Benefits (EOB) that shows itemized payment amounts for each procedure, you must post a total payment.
Note: You must first create an insurance claim before you can post an insurance payment.
Using the Itemized Payment option, you can enter the payment amount for each procedure attached to the claim. As a result, if you itemize payments, you can keep track of what insurance companies actually pay. Being able to accurately estimate how much an insurance company will pay for a procedure is extremely important when you present recommended treatment with insurance estimates to a patient and collect payment after treatment.
The following example demonstrates the benefits of itemizing payments:
An insurance company pays 50% on crowns. If your normal fee for a crown is $600, the insurance payment is estimated to be $300 or 50%. However, when you receive payment, the insurance company's allowable charge for crowns is only $250. If you itemize the payment, the allowable charge amount is retained. The next time a patient on this plan comes in for a crown, the coverage estimate is $250 rather than $300.
Keeping this example in mind, we recommend itemizing payments when you post insurance payments.
To post an insurance payment to an insurance claim
1. After creating an insurance claim, from the Ledger transaction log, double-click the claim that you want to enter a payment for.
The Primary (or Secondary) Dental Insurance Claim window appears.
Note: For new offices, if you did not create the claim that you are posting payment for using Dentrix, you should post the insurance payment as a guarantor payment. You can add a payment type called “Insurance Payment” to distinguish these payments from patient payments. For more information on posting a guarantor payment, see Posting payments.
2. From the Enter Payment menu, click Itemize by Procedure or Enter Additional Payment.
Note: If you select Enter Additional Payment, the Total Insurance Payment dialog box appears. Skip to step 4.
3. If you selected Itemize by Procedure, in the Itemize Payment dialog box you have two options:
· The estimated insurance portion is automatically entered in the Amount Paid field. If the amount is correct, click OK.
· If the insurance cheque amount is different from what appears in the Amount Paid field, type the correct amount in the Payment Table field, and then click OK.
Note: When you itemize payments, only update the Payment Table when the payment amount applies to all patients covered by that plan. For example, if the estimated insurance portion is different from the payment amount because money is being withheld toward a deductible or a patient has exceeded his or her maximum benefit, you should not update the Payment Table.
4. Repeat this process for all other procedures attached to the claim.
Once all procedures have been paid, the Total Insurance Payment dialog box appears.
5. In the Cheque # text box, enter the cheque number of the insurance payment.
Note: This text box accepts up to 20 characters.
6. In the Bank/Branch # text box, enter the Bank/Branch Number on the insurance cheque.
This number prints on the Dentrix Deposit Slip.
7. If you received a cheque for the insurance payment, select Cheque Payment. If you received the insurance payment electronically, select Electronic Payment.
8. If money has been withheld toward a deductible, enter the amount withheld in the appropriate deductible text boxes.
9. If you have not already itemized the payment, complete the following steps to enter the Total Amount Paid:
a. Under Provider Amounts, select Family Balance to calculate the provider balances for the whole family. Select Patient Balance to calculate the provider balances for the patient’s balance.
b. If the provider to whom you want to credit the payment is not listed, click Add. Next, click the Provider search button. Then, select the desired provider, and click OK. Or, if the provider is listed, select the provider to whom you want to credit the payment and click Edit. Next, enter or edit the payment information, and click OK.
c. Click Re-apply Amt Paid using FIFO to re-apply the amount of the total payment to the oldest provider balances first, then to more recent provider balances (if any of the payment amount is left over to do so).
10. In cases where your office does not bill the patient, such as with some preferred provider (PPO) plans, you can quickly create an adjustment to offset any remaining balance. To make an adjustment:
a. Under Enter Adjustment, select Write-Off.
b. Select $ to adjust off a dollar amount or % to adjust off a percentage of the claim’s remaining balance. If you selected the $ option, the unpaid balance for the claim appears in the Total Amount field, but you can change the amount if necessary. If you selected the % option, the unpaid balance for the claim appears in the of field. Enter the percentage to be adjusted in the % field. Dentrix will display the calculated adjustment amount in the = field.
11. If you received a partial payment for the claim, select Claim is partially paid.
The claim is flagged as partially paid and will not have a status of "Received." You can change the flag whenever you add or edit an insurance payment, or you can change the flag using the Insurance Claim Status dialog box.
12. Click OK/Post to post the payment to the Ledger and return to the Dental Insurance Claim window. To return to the Ledger, click File, and then click Exit.
Notes: If you selected Write-Off, the Enter Adjustment dialog box appears. Make any necessary adjustments to the adjustment type, provider, and amount, and then click OK to post the insurance payment and corresponding adjustment.
If the patient has secondary coverage, a message appears and prompts you to create a secondary claim. Click OK and then from the Claim menu, click Create Secondary. To print the secondary claim, from the Secondary Claim menu, click Print. When you are finished, from the File menu, click Exit to return to the Ledger.