Managing Patient Accounts > Using Ortho Contracts
Use the Primary Claim and Secondary Claim tabs to enter the details of claims to submit to the patient’s primary and secondary insurance. The amounts on these tabs are the total amounts for the treatment fee, the initial fee and the monthly fee, not just the amounts you expect insurance to pay.
The Total tx fee field contains the amount entered in the Contract total amount field in the Contract Information area.
To complete this tab:
In the Initial fee field, enter the total amount of the initial fee to submit to primary insurance.
In the Monthly fee field, enter the amount you want to submit to primary insurance for each month's treatment. If you enter the length of treatment in the next field, you can click Calc monthly fee to calculate this for you.
In the Estimated length of tx (months) field, enter the number of months you expect the ortho treatment to take.
In the Freq. of submissions field, select the frequency with which claims will be submitted for this treatment plan. This field is used to generate the claims schedule.
In the Detail type field, select which details to include on the continuation-of-treatment claims. If you select By actual visit dates, the date of the first appointment in each month during the claim period is used, and if the patient missed a calendar month, the date the charge was posted that month is used.
In the Initial claim submit date field, enter the date that the claim for the initial fee will be submitted. Typically, this date is the same as the Ortho appliances placed – estimated field in the Contract Information section. You can select a later date if necessary. When the contract is activated and the initial claim is submitted, a memo appears to the right of this field indicating the date it was submitted.
In the First cont of tx claim date field, enter the date on which you want to submit the first continuation-of-treatment claim. This field is used to calculate the claims schedule. You should use the insurance company’s requirements to determine this date; however, there are two general rules:
If the Detail type is By actual visit dates, use the last day of the month.
If the Detail type is By schedule dates, this date should be no earlier than the day of the month of the First recurring charge date field on the corresponding insurance tab.
If you submit a pre-determination, use the Authorization # field to record the number you receive from the insurance company.