Using the Primary and Secondary Insurance Tabs

Use the Primary Insurance and Secondary Insurance tabs to enter the details of the payments you expect to receive from the patient’s primary and secondary insurance, and to generate a payment schedule that charges each payment amount to production. These dates and schedules can, but do not necessarily, coincide with the dates and schedules on the Primary Claim and Secondary Claim tabs.

You can charge the primary insurance portion to production on a monthly basis, which reflects when you perform the services for the patient. However, the patient's primary insurance company might require that claims be submitted quarterly. In that case, the three monthly charges to production from the Primary Insurance tab occur, and then a claim is submitted according to the Primary Claim tab. By the time the claim is actually paid, the first of the three monthly charges that were included on the claim will be more than 60 days old, which reflects in the account aging. You must decide which is of greater priority: accurate recognition of income per month, or accurate aging of the accounts (since you will not receive insurance payments more than quarterly, the aging is more accurate if you charge to production quarterly).

The Primary insurance est field contains the amount entered in the Estimated Prim ins field in the Contract Information area. This is the amount you are estimating the primary insurance to pay, according the terms defined in the rest of the fields on this tab.

To complete the Primary Insurance tab:

In the Initial fee amount field, enter the amount you estimate the primary insurance will pay from the initial insurance claim you submit for the initial fee. It is charged to production and begins aging on the day the contract is activated, or on the Initial fee due date below.

In the Initial fee Producer field, select the producer to whom the initial fee amount is posted.

For the Initial fee tx code to charge to production, click Select. The Transaction Code Pick List is displayed. Select the appropriate code and click OK.

Use the ADA code for the type of orthodontic treatment the patient is receiving.

The Remaining balance is automatically calculated. This amount is divided into payments based on the rest of the entries on this tab.

If you know the specific recurring payment amount the primary insurance pays, enter that in the Recurring payment amt field. If you know only the length of treatment, leave this field blank and it is calculated for you.

In the Recurring payment amt Producer field, select the Producer to whom each of the recurring payments will be posted over the life of the payment schedule. Typically, it is the patient's primary doctor.

For the Recurring payment amt tx code to charge to production, click Select. The Transaction Code Pick List is displayed.

Select the appropriate code and click OK.

Use the ADA code for the type of orthodontic treatment the patient is receiving.

If you know the specific number of payments the primary insurance is going to pay, enter that number in the Number of payments field. If you do not know the specific amount insurance will pay, enter the length of treatment, in months, in this field.

In the Initial fee due date field, enter the date that the primary insurance estimate for the initial fee will be charged to production. When the contract is activated and the initial fee is charged out, a memo appears to the right of this field indicating the date it was charged.

In the First payment due date field, enter the date of the first recurring payment.