Product Enhancements and New Features:
Insurance Estimating Enhancements
In response to customer requests, the process for identifying patient due amounts vs. insurance/write-off amounts has been improved, along with your ability to access and edit details to provide a more accurate accounting of the patient due amount. These amounts are based on the insurance estimation process which calculates the expected insurance coverage amount and write-offs.
On the Patient Ledger:
- The Ins Share amount is the sum of insurance balances for all open dental claims (from the primary insurance used when services were rendered/claimed) and the expected write-off amount.
Note: If Ortho features are activated, any Ortho Contract amounts are included.
- The Patient Share amount is the Total Due minus the Ins Share.
Click the pencil icon to review the open claims or any open ortho contracts currently contributing to the Ins Share balance. You can use the wrench icon to make any necessary adjustments.
For Ortho practices, the Patient Share is the Current Balance amount minus the Ins Share.
Ortho Contracts and Continuation of Treatment (COT) claims are now linked to their underlying contracts. When a contract is open/active, the contribution to Ins Share is calculated as follows:
- Sum of posted (periodic) insurance charges, posted insurance down payments (charges), and any insurance adjustments (e.g., pre-pay adjustments)
- Minus insurance payments (against ortho or COT claims) and any contracted insurance write-offs against ortho or COT claims
Note: Ortho contract amounts are shown in Ins Share, but cannot be adjusted from the ledger. To adjust insurance coverage on a contract, select Patient > Financials > Contracts > Edit Contract.
Note: Once a claim or contract is closed, transactions associated with the claim or contract are no longer included in the Ins Share calculation. Any residual balance is included in the Patient Share.
Because automatic insurance estimation of medical claims is not currently supported, all claimed amounts (if the claim is medical and the primary claim) are initially calculated as Patient Share. However, you can you can now manually adjust the Ins Share details of an open medical claim to calculate the Patient Share while awaiting reimbursement. The covered amounts for medical claims are usually obtained directly from the insurance company.
To manually adjust the Ins Share amount:
- From the Patient Ledger, Ins Share tile, click the pencil icon. The Manage or Adjust Open Claims window is displayed.
- Select the wrench icon next to the medical claim you want to adjust. The Adjust Claim Estimation window is displayed.
- Enter the Est Ins and Ins W/O amounts. The patient share is automatically calculated.
- Click Adjust. The associated claim and Patient Share balance amounts are updated.
The ability to view and adjust estimation amounts requires the appropriate user permissions. (Administration > Permissions > User Permissions)
- Insurance Claims Management
- Claim Estimation Adjustments
For more information, see: How to Work With the Patient Ledger, Insurance Estimation Overview, and How to View and Manually Adjust the Insurance and Patient Share Estimation.
2024 CDT Code Set Update
Sensei Cloud now contains the 2024 CDT Code set updates, which include:
- 14 new and 2 modified codes
- Codes for sleep apnea (beginning with "99")
Sleep Apnea Treatment Type
To help facilitate the use of the new Sleep Apnea CDT Codes, a Treatment Type was also added. To access the Sleep Apnea codes:
- Select Administration > Procedures & Fees > Procedure List & Fee Schedule.
- In the Treatment Types filter field, type Sleep Apnea. The related codes are displayed.
Transaction List Reporting Enhancement
The Transaction List Report (Dashboard > Reports > Transaction List) now automatically filters out corrected and removed entries by default. If you want to include those entries in the list/report, select the Include Corrected & Removed checkbox under the Applied Filter List.
For more information, see How to Generate Transaction Reports.
Medical Claim - Referring Provider Information
Practices with the Medical Billing feature activated can now include referring provider information on paper medical claims.
For a referral source to be selected for inclusion on a medical claim, it must meet the following criteria:
- Be an active referral source in the system.
- Be actively associated with the patient.
- Have a defined NPI number in the main record of the source.
To select this option:
- From the Claims Management screen, select the medical claim to expand the details.
- Click the Edit Addl Info button. The Additional Claim Information window is displayed for the claim.
- Scroll down to Item 17. Referring Provider Information.
- Select the checkbox, and then select a Referral Source.
- Click Save Changes.
For more information, see Sensei Cloud Medical Billing.
Implant Tracking Merge Fields
Practices using the Implant Tracking feature can now select an Implant Details merge field for clinical notes and correspondence templates. When the merge field is selected, it pulls the most recent data from the patient's Implant Tracking card in the Clinical Chart (EMR) at the time the note or correspondence is generated.
For more information, see How to Track Implants in the Clinical Chart (EMR).
Defects and Small Enhancements
18 additional defects were addressed.