Performing Insurance Functions > Automatic Claims

Creating a Claim When Entering a Contract

When you enter a new contract, the software creates an Actual or Pre-Authorization insurance claim, provided the conditions listed under Automatic Claim Setup are met.

Included on the claim are the contract description, date created, total contract amount, initial fee, estimated treatment time, monthly fee, and quarterly fee.

To create the claim from a new contract:

1. When setting up a contract in the Financial Functions — Contracts and Payment Plans window, you must enter the contract description with a hyphen before the seventh character position. ExampleTo create a claim for a full treatment contract, enter: D8070-Comp. Ortho Treatment Adult Dentition.

2. The hyphen placement in the contract description is crucial; it triggers the software to automatically generate an insurance claim.

2. Complete the contract entry as described in Setting Up a Contract.

3. After entering the contract, click the Claims button in the Financial Functions — Contracts and Payment Plans window. The Claims window is displayed.

4. If more than one claim is displayed, select the claim with the current date and click Change. The Editing Claim Form for <Name> window is displayed.

5. Scroll to the bottom of the form and review the Description of Services section for accuracy. The claim can be edited, if necessary. More...

   Based on the contract description, any wording to the right of the dash (for example, Comp. Ortho Treatment Adult Dentition) displays on the top line of the Description of Services section.

   Characters to the left of the dash (for example, D8070) display in the corresponding Proc. No. (ADA) column on the claim form.

   The contract total (combined responsible party and insurance) is displayed in the Fee column.

   The Initial Fee is calculated by adding the initial fees for all responsible parties and insurance carriers between whom the contract was split.

   The Estimated Length of Treatment is the difference between the first and last month of the contract that has the greatest spread.

   The Per Month amount written out to the insurance claim in the Description of Services section is calculated in the following manner:

   Contract Total Fee:	4,500.00
   Minus Initial Fee combined amounts:	(RP + Ins)      -(500.00 + 500.00)
   Divided by Estimated Length of Treatment:	3,500 ÷ 24
   Per Month:	145.83
   Per Quarter:	145.83 x 3 = 437.50

    

Related Topics

Automatic Claims

Automatic Claim Setup

Creating a Claim When Posting Procedures

Hints and Tips for Working with Automatic Claims