Medicaid Cost Report

The Medicaid Cost Report displays cost information (charges, adjustments, and net insurance payments) regarding procedures billed to insurance carriers that you may be able to submit to Medicaid. The report displays procedures that are associated only with dental claims.

To generate the report

In DXOne Reporting, select Custom, and then double-click Medicaid Cost Report.

The Medicaid Cost Report dialog box appears.

Set up the following options:

Date Range - To filter the report by date, do one of the following:

To include procedures on claims that have service dates within a range that you specify, select the Specific Range option. With this option selected, do one of the following:

Enter a date range (in a m/d/yyyy format) in the From and To boxes.

To select a date, do the following for From and To:

Click the corresponding calendar icon to view a month calendar.

Navigate to the correct month using the left and right arrows.

Note: To quickly change the year and month, click the month-year at the top of the calendar, navigate to the correct year using the left and right arrows, and then click the correct month.

Click the correct day.

To include procedures on claims that have service dates within a range that is relative to the report date, select the Relative Date Range option. With this option selected, select one of the following relative date ranges from the list:

Date Based On - Select one of the following options:

Service Date - To include a procedure on a claim based on the service date of the procedure.

Primary Claim Date - To include a procedure on a primary claim based on the creation date of the claim.

Secondary Claim Date - To include a procedure on a secondary claim based on the creation date of the claim.

Tertiary Claim Date - To include a procedure on a tertiary claim based on the creation date of the claim.

Quaternary Claim Date - To include a procedure on a quaternary claim based on the creation date of the claim.

Insurance Carrier - To filter the report by insurance carriers, do one of the following:

To include all insurance carriers, select the All checkbox.

To include specific insurance carriers, do the following:

Click the search button .

The Select Insurance Carrier dialog box appears.

If the list is long, to search for insurance carriers by name, group plan name, group plan number, and/or local number, do the following:

Click Search.

The options for searching appear in the upper list.

Enter the first character or more of an insurance carrier name, group plan name, group plan number, and/or local number in the Carrier Name, Group Plan, Group#, and Local# boxes, respectively.

Click Show Results to view a list of matching insurance carriers.

Note: To return to viewing the list of all the insurance carriers, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.

In the upper list, select one or more insurance carriers.

Note: To select multiple insurance carriers, click an insurance carrier, and then, while pressing the Ctrl key, click the other desired insurance carriers. To select a range of adjacent insurance carriers, click the first insurance carrier of the desired range of insurance carriers, and then, while pressing the Shift key, click the last insurance carrier of the desired range of insurance carriers.

Click Add.

Repeat steps b-d as needed to add other insurance carriers.

Note: To remove an insurance carrier that you added, select that insurance carrier in the lower list, and then click Remove.

Click OK.

Clinic - To filter the report by the clinics that are associated with procedures on claims, do one of the following:

To include all clinics that you are allowed to generate the report for, select the All checkbox.

To include specific clinics, do the following:

Click the search button .

The Select Clinics dialog box appears.

Note: Only the clinics that you are allowed to generate the report for are available.

If the list is long, to search for a clinic by ID and/or title, do the following:

Click Search.

The options for searching appear in the upper list.

Enter the first character or more of a clinic's ID and/or title in the ID and Practice Title boxes, respectively.

Click Show Results to view a list of matching clinics.

Note: To return to viewing the list of all the clinics, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.

In the upper list, select one or more clinics.

Note: To select multiple clinics, click a clinic, and then, while pressing the Ctrl key, click the other desired clinics. To select a range of adjacent clinics, click the first clinic of the desired range of clinics, and then, while pressing the Shift key, click the last clinic of the desired range of clinics.

Click Add.

Repeat steps b-d as needed to add other clinics.

Note: To remove a clinic that you added, select that clinic in the lower list, and then click Remove.

Click OK.

Provider - To filter the report by the providers that are associated with procedures on claims, do one of the following:

To include all providers that you are allowed to generate the report for, select the All checkbox.

To include specific providers, do the following:

Click the search button .

The Select Providers/Staff dialog box appears.

Note: Only the providers and staff that you are allowed to generate the report for are available.

If the list is long, to search for a provider by ID, first name, last name, and/or title, do the following:

Click Search.

The options for searching appear in the upper list.

Enter the first character or more of a provider's ID, first name, last name, and/or title in the ID, First Name, Last Name, and Title boxes, respectively.

Click Show Results to view a list of matching providers and staff members.

Note: To return to viewing the list of all the providers and staff members, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.

In the upper list, select one or more providers.

Note: To select multiple providers, click a provider, and then, while pressing the Ctrl key, click the other desired providers. To select a range of adjacent providers, click the first provider of the desired range of providers, and then, while pressing the Shift key, click the last provider of the desired range of providers.

Click Add.

Repeat steps b-d as needed to add other providers.

Note: To remove a provider that you added, select that provider in the lower list, and then click Remove.

Click OK.

ADA Code - To filter the report by procedure codes, do one of the following:

To include all procedure codes, select the All checkbox.

To include specific procedure codes, do the following:

Click the search button .

The Select ADA Codes dialog box appears.

Do one of the following:

To get a list of all procedure codes, do not enter any search criteria.

To search for procedure codes by category, abbreviated description, ADA code, and/or description, enter the first character or more of a procedure code category, abbreviated description, ADA code, and/or ADA description in the Category, User Code, ADA Code, and/or Description boxes, respectively.

Click Show Results to view a list of matching procedure codes.

Note: To clear the search criteria that you entered so you can search again, click Search, and then click Clear Search. Then, repeat steps b-c.

In the upper list, select one or more procedure codes.

Note: To select multiple procedure codes, click a procedure code, and then, while pressing the Ctrl key, click the other desired procedure codes. To select a range of adjacent procedure codes, click the first procedure code of the desired range of procedure codes, and then, while pressing the Shift key, click the last procedure code of the desired range of procedure codes.

Click Add.

Repeat steps b-e as needed to add other procedure codes.

Note: To remove a procedure code that you added, select that procedure code in the lower list, and then click Remove.

Click OK.

Patient Tag - Do one of the following:

To not filter the report by a patient tag, clear the Run By Patient Tag checkbox.

To filter the report by the tags that are assigned to patients who have procedures that are attached to claims in their records, select the Run By Patient Tag checkbox. With this checkbox selected, the options to filter the report by tag are available. Do one of the following:

To include patients with any patient tag, select the All checkbox.

To include patients with specific tags, do the following:

Click the search button .

The Patient Tag Selection dialog box appears.

If the list is long, to search for a patient tag, do the following:

Click Search.

The options for searching appear in the upper list.

Enter the first character or more of a patient tag name in the Tag Name box.

Click Show Results to view a list of matching patient tags.

Note: To return to viewing the list of all the patient tags, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.

In the upper list, select one or more patient tags.

Note: To select multiple patient tags, click a patient tag, and then, while pressing the Ctrl key, click the other desired patient tags. To select a range of adjacent patient tags, click the first patient tag of the desired range of patient tags, and then, while pressing the Shift key, click the last patient tag of the desired range of patient tags.

Click Add.

Repeat steps b-d as needed to add other patient tags.

Note: To remove a patient tag that you added, select that patient tag in the lower list, and then click Remove.

Click OK.

Include - Select one of the following options:

All Claims - To include a procedure on a claim whether or not a patient or insurance payment has been applied to it.

Paid Claims Only - To include a procedure on a claim only if a patient or insurance payment has been applied to it.

Other Options - Select or clear the following checkboxes:

Excel Friendly - This checkbox is always selected, so the report displays the data in a format that you can easily export to a spreadsheet program. You cannot clear this checkbox.

Include Report Headers - With this checkbox selected, the report details appear on the first page (cover page) of the report. With this checkbox clear, there is not a cover page with report details.

Report Format Options - Select one of the following options:

Details - With this option selected, all report filters are available. The report includes details for each procedure on separate lines. Each line also includes insurance plan and claim information.

Summary - With this option selected, Service Date is used for Date Based on (the other options are not available), the Insurance Carrier selection is ignored (and is not available), the Provider selection is ignored (and the option is not available), and the ADA Code selection is ignored (and the option is not available). The report includes a summary of details for each patient's date of service on separate lines. The report does not include insurance plan or claim information.

Summary with Insurance - With this option selected, Service Date is used for Date Based on (the other options are not available), the Provider selection is ignored (and the option is not available), and the ADA Code selection is ignored (and the option is not available). The report includes a summary of details for each patient's date of service on separate lines. Each line also includes insurance plan and claim information.

Click Save as Default to save the current settings for the next time you run the report.

Click Clear Defaults to revert the dialog box options to the original defaults.

Click Schedule to schedule a report job.

Click OK to preview the report.

Detailed Report

For each procedure, the following details appear:

Patient First Name - The first name of the patient.

Patient Last Name - The last name of the patient.

Patient Date of Birth - The birth date of the patient.

Patient Social Security Number - The SSN of the patient.

Office Name - The practice title of the clinic.

Rendering Provider - The name of the provider (in a LastName, FirstName format).

Provider Type - The provider's specialty.

Provider Medicaid Number - The provider's Medicaid number.

Service Date - The service date of the procedures associated with the claim.

Procedure Code - The ADA Procedure Code.

Procedure Description - The ADA Procedure Code description.

Charge - The amount charged.

Adjustments - The sum of all credit adjustments associated with the charge.

Patient Payment - The sum of all patient payments associated with the charge.

Primary Claim Number - A unique number that identifies the primary claim.

Primary Claim Date - The creation date of the primary claim.

Net Payment by Primary Payer - The sum of all primary insurance payments associated with the charges on the primary claim.

Patient Primary Insurance Name - The name of the patient's primary insurance carrier.

Patient Primary Insurance Subscriber # - The subscriber ID for the patient's primary insurance plan.

Patient Primary Insurance Allowed - The estimated primary insurance portion of all charges on the primary claim.

Patient Primary Insurance Reimbursement - The source of payment for the primary insurance plan.

Secondary Claim Number - A unique number that identifies the secondary claim.

Secondary Claim Date - The creation date of the secondary claim.

Net Payment by Secondary Payer - The sum of all secondary insurance payments associated with the charges on the secondary claim.

Patient Secondary Insurance Name - The name of the patient's secondary insurance carrier.

Patient Secondary Insurance Subscriber # - The subscriber ID for the patient's secondary insurance plan.

Patient Secondary Insurance Allowed - The estimated secondary insurance portion of all charges on the secondary claim.

Patient Secondary Insurance Reimbursement - The source of payment for the secondary insurance plan.

Tertiary Claim Number - A unique number that identifies the tertiary claim.

Tertiary Claim Date - The creation date of the tertiary claim.

Net Payment by Tertiary Payer - The sum of all tertiary insurance payments associated with the charges on the tertiary claim.

Patient Tertiary Insurance Name - The name of the patient's tertiary insurance carrier.

Patient Tertiary Insurance Subscriber # - The subscriber ID for the patient's tertiary insurance plan.

Patient Tertiary Insurance Allowed - The estimated tertiary insurance portion of all charges on a tertiary claim.

Patient Tertiary Insurance Reimbursement - The source of payment for the tertiary insurance plan.

Quaternary Claim Number - A unique number that identifies the quaternary claim.

Quaternary Claim Date - The creation date of the quaternary claim.

Net Payment by Quaternary Payer - The sum of all quaternary insurance payments associated with the charges on the quaternary claim.

Patient Quaternary Insurance Name - The name of the patient's quaternary insurance carrier.

Patient Quaternary Insurance Subscriber # - The subscriber ID for the patient's quaternary insurance plan.

Patient Quaternary Insurance Allowed - The estimated quaternary insurance portion of all charges on a quaternary claim.

Patient Quaternary Insurance Reimbursement - The source of payment for the quaternary insurance plan.

Summary Report

For each patient's date of service, the following details appear:

Patient First Name - The first name of the patient.

Patient Last Name - The last name of the patient.

Patient Date of Birth - The birth date of the patient.

Patient Social Security Number - The SSN of the patient.

Office Name - The practice title of the clinic.

Service Date - The service date of the procedures associated with a claim.

Net Charges - The sum of all the charges associated with a claim.

Net Adjustments - The sum of all credit adjustments associated with the charges on a claim.

Net Patient Payments - The sum of all patient payments associated with the charges on a claim.

Net Insurance Payments - The sum of all the insurance payments associated with the charges on a claim.

Summary with Insurance Report

For each patient's date of service, the following details appear:

Patient First Name - The first name of the patient.

Patient Last Name - The last name of the patient.

Patient Date of Birth - The birth date of the patient.

Patient Social Security Number - The SSN of the patient.

Office Name - The practice title of the clinic.

Service Date - The service date of the procedures associated with a claim.

Net Charges - The sum of all the charges associated with a claim.

Net Adjustments - The sum of all credit adjustments associated with the charges on a claim.

Net Patient Payments - The sum of all patient payments associated with the charges on a claim.

Primary Claim Number - A unique number that identifies the primary claim.

Primary Claim Date - The creation date of the primary claim.

Net Payment by Primary Payer - The sum of all primary insurance payments associated with the charges on the primary claim.

Patient Primary Insurance Name - The name of the patient's primary insurance carrier.

Patient Primary Insurance Subscriber # - The subscriber ID for the patient's primary insurance plan.

Patient Primary Insurance Allowed - The estimated primary insurance portion of all charges on the primary claim.

Patient Primary Insurance Reimbursement - The source of payment for the primary insurance plan.

Secondary Claim Number - A unique number that identifies the secondary claim.

Secondary Claim Date - The creation date of the secondary claim.

Net Payment by Secondary Payer - The sum of all secondary insurance payments associated with the charges on the secondary claim.

Patient Secondary Insurance Name - The name of the patient's secondary insurance carrier.

Patient Secondary Insurance Subscriber # - The subscriber ID for the patient's secondary insurance plan.

Patient Secondary Insurance Allowed - The estimated secondary insurance portion of all charges on the secondary claim.

Patient Secondary Insurance Reimbursement - The source of payment for the secondary insurance plan.

Tertiary Claim Number - A unique number that identifies the tertiary claim.

Tertiary Claim Date - The creation date of the tertiary claim.

Net Payment by Tertiary Payer - The sum of all tertiary insurance payments associated with the charges on the tertiary claim.

Patient Tertiary Insurance Name - The name of the patient's tertiary insurance carrier.

Patient Tertiary Insurance Subscriber # - The subscriber ID for the patient's tertiary insurance plan.

Patient Tertiary Insurance Allowed - The estimated tertiary insurance portion of all charges on a tertiary claim.

Patient Tertiary Insurance Reimbursement - The source of payment for the tertiary insurance plan.

Quaternary Claim Number - A unique number that identifies the quaternary claim.

Quaternary Claim Date - The creation date of the quaternary claim.

Net Payment by Quaternary Payer - The sum of all quaternary insurance payments associated with the charges on the quaternary claim.

Patient Quaternary Insurance Name - The name of the patient's quaternary insurance carrier.

Patient Quaternary Insurance Subscriber # - The subscriber ID for the patient's quaternary insurance plan.

Patient Quaternary Insurance Allowed - The estimated quaternary insurance portion of all charges on a quaternary claim.

Patient Quaternary Insurance Reimbursement - The source of payment for the quaternary insurance plan.