Creating a Claim Manually

To create an insurance claim manually:

In the patient chart or from one of the Financial Functions windows, click the Claims button. The Claims window is displayed.
Click Add New. If there is more than one responsible party for this patient, the Policy Holders window is displayed.

Select the responsible party who is the policy holder for the claim being entered and click OK.

If the responsible party has more than one carrier, the Insurance Plans window is displayed.

Select the carrier you want to make a claim against and click OK. The Add New Claim window is displayed.

If there is a single policy holder and only one carrier, the Add New Claim window is displayed.

Select the type of claim you want to create and click OK. The Adding Claim Form window is displayed.

Use the scroll bar to view the entire form, and use the mouse to click in the fields in which you need to enter information. Many of the fields are automatically populated by the software. Click herehere to view some fields you might need to fill in, depending on the claim type.

Insurance Claim Fields

Claim Type	Fields to Populate
Pre-Authorization	First Visit Date Description of Services
Actual	First Visit Date Months Tx. Remaining Description of Services
Continuation of Treatment	First Visit Date Months Tx. Remaining
One-Time	First Visit Date Description of Services

Enter the following informationfollowing information in the fields.

First Visit Date — Type the date of the patient’s first visit.
When entering new claims (Actual, One-Time, and Continuation of Treatment), be sure to enter the First Visit Date in the claim window. If you forget this date, the insurance carrier can reject the claim.
Description of Services — Type the treatment description, using the following buttons:
Click Insert to add a line to the Description of Services section.
Click Remove to delete a line.
Click Clear to remove the text from a line.
Click Add Procedures. The Procedures window is displayed, enabling you to include a procedure code in the Description of Services section. Select a procedure from the list and click OK.
Click in the Cavity column to add an oral cavity code for a procedure, if applicable.
Procedures that are marked as Oral Cavity Required require that you enter an alphanumeric cavity code (e.g., LL, LR, UR, UL, etc.) in the Cavity column of the line. If you try to save the claim without entering the required information, a message is displayed: Oral Cavity value required for the procedure code at line no: [X] in Record of Services.
Months Tx. Remaining — Type the number of months left in the patient’s treatment.
This field is often mandatory for a carrier to process Continuation of Treatment claims.

Use the buttons at the bottom of the window to add additional informationadditional information to the claim:
- Remarks — Click Remarks to add comments to an electronic claim. The software stores comment information differently for electronic claims. For actual charge lines in the Description of Service section to be saved for electronic submission, the software stores the lines found with Date, Proc. No, and Fee all in one line.
  
  When the electronic claim is created, the comment lines are stored in a separate area from lines containing the Date, Proc. No. (ADA Code), and Fee. Use the Remarks window to add up to 103 characters of comment information.
  
  Comments are items that the insurance carrier needs in addition to the normal procedure code, date, and fee. These items are not included on the electronic claim if placed in the Description of Services section.
- Print — Click Print to print the claim. You must have blank claims loaded in the printer.
- Tooth Chart — Click Tooth Chart to display the standard AAO tooth chart.
- History — Click History to display the Claim History window. This window is only used for a Pre-Authorization claim and for the initial setup of a Continuation of Treatment claim.
  
  For a Pre-Authorization claim, you can use this window to enter the date the claim was approved by the insurance company in the Date Approved field.
  
  You also use the Claim History window the first time you set up a Continuation of Treatment claim. See Creating a Continuation of Treatment Claim for more information.
Click OK.
The Medicaid ID prints in fields 52A and 58 on the ADA 2012 insurance claim form.