Managing Insurance Claims

Related Training

To manage claims for a location or for all locations in a practice, use the Claims Management window. From the Location tab, select Claims > Claims Management. The Claims Management window is displayed, listing the claims for the location.

For each claim, you can view the Claim Number, Status, D/M (dental/medical), Claim Type, COV (primary or secondary), Provider, Last Updated Date, Payer, Plan, Patient Name, Billed Amount, and Paid Amount.

You can:

Sort the list by any column.
Search claims by patient, policyholder, claim ID, and procedure code.
Display only the claims that are cancelled, pending review, or awaiting attachments.
Click the Export Report option to create a .CSV file of the list.

Claims that require action display an Alert icon in the Status column.

The claim type is assigned automatically when a claim is generated:

Svc—Statement of actual services
Pre-Auth—Request for pre-authorization
COT—Continuation of treatment for orthodontic services
Ortho—Initial claim for orthodontic treatment

To view a claim summary, select a claim in the list. The Claim Summary window is displayed.

In the Claim Summary window, you can:

View the claim details
Enter a pre-authorization reference number
Edit ICD-10 medical diagnosis codes
Submit unsubmitted claims
Print claims
Apply payments
Edit additional information
Update the claim status
Cancel the claim

Adding a Pre-Authorization Reference Number

You can manually add a pre-authorization number that was received from an insurance payer from a portal, phone call, fax, and so on, to both medical and dental insurance claims.

To add a pre-authorization number to a claim:

On the Patient tab, select Insurance > Claims Management.
Select the appropriate claim. The Claim Summary is displayed.
Click Add Reference #. The Add Claim Pre-Authorization Reference # window is displayed.

Type the reference number, and click Save. The saved pre-authorization number is automatically populated on dental and medical claims, paper and electronic.

If you need to edit the pre-authorization reference number, click the number in the Claim Summary to display the Add Claim Pre-Authorization Reference # window and make the changes.