What's New in Version 14.0

Insurance Features

Several enhancements have been made to insurance functions:

Sorting Completed Claims By Patient Name

The Completed Claim List window (List > Completed Claim) now has a Name sort option, enabling you to sort the completed claims by patient name.

When the Name sort option is selected, the list is sorted by the last name of the patient associated with the claim. If there are claims for multiple patients with the same last name, the list is further sorted by ID. If there are multiple claims for the same patient, the list is further sorted by claim ID.

Viewing a Log File for Claims Deleted After Running the Resubmit or Delete by Age Function

You can now view and print a log file reflecting the claims that are deleted as a result of running the Resubmit/Delete by Age function.

See Resubmitting Claims by Age and Deleting Claims By Age for more information.

Contact Notes Available in the Claim List, Claim, and Completed Claim Windows

You can now access contact notes for claims in the Claim List, Claim, and Completed Claim windows.

The Contacts By Date and Contacts By Type options have been added to the Options menu for each of the above windows.

Contact notes work the same way in these windows as they do in other areas of the software:

• Selecting Contacts By Date displays a list of contacts for the selected claim sorted by date.

• Selecting Contacts By Type displays a list of contacts for the selected claim sorted by type.

• Selecting Print prints a copy of the Contacts List.

• Double-clicking on a contact displays a window where you can edit the contact.

When a claim is paid and marked complete, the contacts stay with the claim and can be accessed from the Completed Claim List window.

See Using Contacts for more information.

Estimating Secondary Insurance Benefits

A new option—Coordinate benefits when used as secondary plan—has been added to the Claim Filing tab of the Insurance Plan window (List > Insurance Plan > Double-click a plan > Claim Filing).

If you select this option, the software estimates the secondary insurance amount based on the total fee minus the deductible, minus the amount already estimated to be paid by the primary plan.

Example:A primary plan pays 78% of a transaction after the patient pays a $50.00 deductible.
$125.00 fee - $50.00 deductible x 78% = $58.50
The secondary plan pays 55% of a transaction after the patient pays a $50.00 deductible and the primary plan amount has been subtracted.
$125.00 fee - $50.00 deductible - $58.50 primary plan amount  x 55% = 9.07

If you do not select this option, the software estimates the secondary amount as it always has, using the total fee and not taking into account the amount already estimated to be paid by the primary plan.

Example:A primary plan pays 78% of a transaction after the patient pays a $50.00 deductible.
$125.00 fee - $50.00 deductible x 78% = $58.50
The secondary plan pays 55% of a transaction after the patient pays a $50.00 deductible.
$125.00 fee - $50 deductible x 55% = $41.25

See Adding Insurance Plans for more information.

Applying a Write-Off to a Patient Balance

A new option—Upgraded Procedure (write-off amount applied to patient balance)—has been added to the Allowance Table window (List > Allowance Table > View Codes > Add/Edit) and the General tab of the Bluebook window (List > Bluebook > Select Plan > Edit).

Whenever the software estimates primary insurance, it checks the bluebook entry to see if the Upgraded Procedure (write-off amount applied to patient balance) option is selected. If it is, the write-off amount that was calculated (the difference between the allowed amount and the fee) is added to the Pat. Pays amount.

If the Upgraded Procedure (write-off amount applied to patient balance) option is not selected, the software takes the write-off amount which was calculated and adds it to the Ins. Pays amount (as it always has).

For plans that do not calculate write-offs, the software estimates the insurance as it always has.

See Editing Allowance Tables and Editing Bluebook Entries for more information.