To create a medical insurance claim, at least one procedure for the claim must be cross coded for medical insurance billing. With a cross-coded procedure, creating and sending a claim can be as simple as clicking one button. You will create an insurance claim each time an insured patient receives treatment. Create claims using the methods that fit into your office's workflow for handling claims.
The following scenarios explain more about how Dentrix Enterprise handles cross-coded procedures:
If procedures that can be cross coded have been posted, but the cross-coding information has not been entered, Dentrix Enterprise will create a dental insurance claim for the procedures.
If a combination of cross-coded and dental procedures have been entered for a day, Dentrix Enterprise will create two insurance claims: a medical insurance claim that includes all cross-coded procedures and a dental insurance claim for procedures that are not cross coded.
If more than four ICD-9 or ICD-10 diagnostic codes have been assigned to the cross-coded procedures, a message will appear. Click OK to assign some of the cross-coded procedures to one or more additional medical insurance claims, or click Cancel to return to Ledger without creating a claim so that you can modify the cross-coding information.
Important: You must purchase HCFA claim forms to print medical claim information on.
Notes:
To have the aggregated amount of payments from other sources appear in box 29 of the HCFA 2012 claim form after you create a medical insurance claim, do the following: submit the primary dental insurance claim; when you receive a payment from the primary dental insurance carrier, enter that payment for the primary dental insurance claim; and then submit the medical insurance claim. Box 29 on the medical insurance claim will now include the aggregated amount of payments from other sources.
Also, you can create a batch of insurance claims from Office Manager.
Creating insurance claims requires the "Insurance Claims, Create New" security right.
Printing insurance claims directly from Ledger requires the "Batch Processor, Print/Display Reports" security right.
Viewing insurance claims requires the "Insurance Claims, Open" security right.
To create a primary medical insurance claim
With a patient selected in Ledger, do one of the following:
Create a claim for today's procedures. This option is the simplest way to create a claim. Use this method for creating a medical insurance claim that includes all the cross-coded procedures that were posted today. Do one of the following:
Click
the Ins. Today's Proc. button
on the toolbar.
The claim will be created and then batched or printed (according to the
direct
print option for insurance claims).
On the Insurance menu, click Today's Procedures. The claim will be created and then displayed, allowing you to edit information for the claim before it is sent. You need to edit the claim only if it requires special handling, such as adding a narrative or attaching X-rays.
On the Insurance menu, click Today's Procedures - Direct Print. The claim will be created and then printed.
On the Insurance menu, click Today's Procedures - Batch. The claim will be created and then batched.
Create a claim for specific procedures. Use this method for creating a medical insurance claim that includes specific cross-coded procedures that were posted either today or on another date. Do the following:
Select the cross-coded procedures for which you want to create a medical insurance claim.
Note: To select multiple procedures, click a procedure, and then, while pressing the Ctrl key, click the other desired procedures.
Do one of the following:
Click
the Ins. Selected Proc. button
on the toolbar.
The claim will be created and then batched or printed (according to the
direct
print option for insurance claims).
On the Insurance menu, click Selected Procedures. The claim will be created and then displayed, allowing you to edit information for the claim before it is sent. You need to edit the claim only if it requires special handling, such as adding a narrative or attaching X-rays.
On the Insurance menu, click Selected Procedures - Direct Print. The claim will be created and then printed.
On the Insurance menu, click Selected Procedures - Batch. The claim will be created and then batched.
If applicable, do one of the following:
If the Password - Insurance Claims, Create New dialog box appears, user verification has been assigned to the "Insurance Claims, Create New" task. Do one of the following:
If your user account has been granted the "Insurance Claims, Create New" security right, enter your credentials in the User ID and Password boxes, and then click OK.
If your user account has not been granted the "Insurance Claims, Create New" security right, have a user with permission temporarily override this restriction so you can create a claim this one time. The overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
If a message appears, informing you that you do not have rights to this operation, your user account has not been granted the "Insurance Claims, Create New" security right. To have a user with permission temporarily override this restriction so you can create a claim this one time, do the following:
On the message, click Yes.
In the Password - Insurance Claims, Create New dialog box, the overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
Dentrix Enterprise creates the claim.
Depending on which method you used to create the claim, do any of the following as applicable:
If you clicked the Ins. Today's Proc. button with the direct print option for insurance claims set to Print, or if you clicked Today's Procedures - Direct Print or Selected Procedures - Direct Print on the Insurance menu:
If the Password - Batch Processor, Print/Display Reports dialog box appears, user verification has been assigned to the "Batch Processor, Print/Display Reports" task. Do one of the following:
If your user account has been granted the "Batch Processor, Print/Display Reports" security right, enter your credentials in the User ID and Password boxes, and then click OK.
If your user account has not been granted the "Batch Processor, Print/Display Reports" security right, have a user with permission temporarily override this restriction so you can print a claim this one time. The overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
If a message appears, informing you that you do not have rights to this operation, your user account has not been granted the "Batch Processor, Print/Display Reports" security right. To have a user with permission temporarily override this restriction so you can print a claim this one time, do the following:
On the message, click Yes.
In the Password - Batch Processor, Print/Display Reports dialog box, the overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
If you clicked Today's Procedures or Selected Procedures on the Insurance menu:
If the Password - Insurance Claims, Open dialog box appears, user verification has been assigned to the "Insurance Claims, Open" task. Do one of the following:
If your user account has been granted the "Insurance Claims, Open" security right, enter your credentials in the User ID and Password boxes, and then click OK.
If your user account has not been granted the "Insurance Claims, Open" security right, have a user with permission temporarily override this restriction so you can view a claim this one time. The overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
If a message appears, informing you that you do not have rights to this operation, your user account has not been granted the "Insurance Claims, Open" security right. To have a user with permission temporarily override this restriction so you can view a claim this one time, do the following:
On the message, click Yes.
In the Password - Insurance Claims, Open dialog box, the overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
One of the following occurs:
Dentrix Enterprise sends the claim to the Batch Processor.
Dentrix Enterprise sends the claim to the default printer for Office Manager.
The Primary Medical Insurance Claim window appears.
