Product Enhancements and New Features:
Insurance Estimation Enhancements (US Only)
Insurance estimation functionality has been enhanced to improve the accuracy and consistency of calculating projected insurance coverage for billable work.
New Default Settings
Customers in the U.S. can enable default settings to automatically update a patient's remaining deductible and benefits, as well as automatically set remaining deductible and benefits to the plan's defaults when the defined coverage period resets.
When enabled, these settings allow for more accurate insurance estimation and prevent you from having to manually update each patient's available coverage every year.
To enable these settings:
- From the Administration tab, select Practice Settings > Financial Rules.
- Click Edit Financial Rules.
- Under Insurance Estimation Defaults, select Yes for each option you want to enable.
- Click Save.
Note: Patient Deductible Remaining amounts update automatically a claim is generated, while Benefits Remaining amounts update whenever an insurance payment is posted.
For more information, see How to Enable Automatic Updates to Patient Remaining Deductible and Benefits.
Sensei Cloud now calculates insurance coverage more consistently, reflecting the procedure order, grouping, available benefits, remaining deductible, and coverage period.
The improved process provides more accurate estimates, and will be evident when you are planning treatment, posting new charges, or generating a claim.
- Estimations are always based on the latest data. This is particularly important now that the deductible and benefits remaining amounts can be automatically updated (based on practice settings) and reduced as procedures are claimed and claims are paid.
- Estimations apply to the overall treatment plan as one large group, as well as to each group within the treatment plan.
- Estimates are based on the specified procedure order, to be consistent with claims and the order in which procedures are adjudicated, resolving potential confusion between the original estimate and the final EOB.
- The estimation logic for a group of procedures is re-applied at the time of posting.
- Re-estimation occurs at the time of claim creation, to account for elapsed time or change in conditions between when work was performed and when it was ultimately claimed, as well as any changes to what was originally estimated (as a group) and what was ultimately claimed.
Updated NHS Claim Numbering (UK Only)
NHS claim numbering now meets the NHS BSA requirements, including the 10-digit contract number, 6-digit performer number, and incrementation of the CLRN for each submission.
Note: No user action is required, as the numbering of existing claims has been automatically applied.
New Merge Fields for Completed Procedures
In response to requests from Oral Surgery customers, three new merge fields have been added, enabling you to update clinical note and correspondence templates to include data on posted procedures. These new options are available in the Clinical category and for all sub-categories within Clinical Notes:
- Completed Procedure
- Completed Procedures and Completed Procedures Description
- Completed Procedures Description
When the clinical note or correspondence template includes these new merge fields, procedure data is merged in for any procedures posted on the associated service date (clinical notes) or the most recent service date (correspondence).
Alternate Procedure Codes on Medical Claims
To help meet payer requirements and/or ensure more accurate adjudication, Sensei Cloud now supports the submission of CDT (dental) codes on medical claims. For example, 41899 is the commonly used CPT code for documenting extractions. However, it does not adequately convey the full context of the procedure. CDT codes - such as D7140, D7210, and D7240 - more accurately reflect the complexity of the completed work. Use of these dental codes on claim forms helps to ensure more accurate adjudication and reimbursement.
In order to include dental codes on medical claims, two setup actions are required:
1 - Flag Insurance Plans for Alternate Billing Codes
For medical insurance payers / plans that require submission of alternate billing codes:
- Select Administration > Insurance > Plans.
- Filter the list by Medical.
- Select a plan from the list. The Update Insurance Plan window is displayed.
- Under Plan Information, select Alt. Procedure Codes.
Note: This option is only available for medical insurance plans.
- Click Update. The plan is now enabled for alternate procedure codes for all patients using the plan.
Note: You can also update a medical insurance plan by selecting it directly from the Insurance section of the Patient Home screen, where it may be listed as either the Primary or Secondary plan.
2 - Select and Flag Dental Codes for Use on Medical Claims
For each alternate procedure code required by applicable payers:
- Select Administration > Procedures & Fees > Procedure List & Fee Schedule.
- Use the filters and search field to display the code types you want to flag (i.e., Extractions).
- Select a code from the list. The Update Procedure window is displayed.
- In the CPT Code field, search for and select a medical billing code to associate with this procedure, (i.e., 41899).
Note: A dental code cannot be included on a medical claim without a CPT code indicated this field.
- Select the Enable Alternate Billing checkbox. This enables this procedure/CDT code to be included on a claim form for any insurance plan with Alt. Procedure Codes enabled.
- Click Update.
Important: These procedure codes must have both a defined CPT code and a CDT code. The CPT code is required to bill the service (posted procedure) to medical insurance. The CDT code is used as the alternate billing code (in place of the CPT code) on the medical claim.
For more information, see How to Bill a Dental Procedure (CDT) Code on a Medical Claim.
Additional Electronic Payer IDs
Sensei Cloud now includes additional (electronic) payer IDs, to better facilitate the successful transmission of insurance claims, particularly to medical payers.
To select or update the Payer ID associated with an insurance payer, select Administration > Insurance > Payers.
Inactive Insurance Plans Hidden by Default
Sensei Cloud now hides inactive insurance plans from search/select fields, preventing you from selecting an outdated plan when entering a patient’s insurance information.
Missing Address Prompt
To help prevent interruptions to correspondence, statement, and insurance claim workflows, Sensei Cloud now prompts you to resolve a missing address when creating or updating a patient record.
If the patient (if self-responsible), a patient's responsible party, or a patient's policyholder does not have a defined address, you are prompted and given the option to update the associated address or to make the update later.
To update patient information, select Patient > Patient Record > Edit Patient Record.
Defects and Small Enhancements
Seven additional defects were addressed.