How to Cancel and Resubmit Continuation of Treatment Claims

 Related Training

Managing Insurance Claims Recorded Class

The process for cancelling and resubmitting a Continuation of Treatment (COT) claim is different from cancelling and resubmitting a non-COT claim. 

This need may arise when:

• Patient insurance changes mid-treatment.
• The claim is rejected due to an error or missing information.
• An active contract is migrated from the practice's previous system.

Why Is This Different?

When you cancel a non-COT claim, the charges revert to the patient's Unbilled list, ready to select for a new claim. With COT claims, the date-specific charges are defined in the contract, and do not revert automatically to the patient's Unbilled list. It is therefore recommended that you:

1. Edit the existing contract to generate a new claim.
2. Cancel the old claim after the new one is created.

Updating a Contract / Generating a New Claim

Edit the existing contract to:

• Remove the existing charge schedule.
• Re-enter the charge amounts.
• Create a new schedule and select a different insurance plan.

To edit a COT contract and generate a new claim:

1. From the Patient tab, select Financials > Contracts.
2. Select the contract to adjust and click Edit Contract.
3. Scroll down to the Contract Charge Schedules section. From here you can:
   - Click Remove Charge Schedule to remove an existing schedule. The guarantor's portion of the contract is recalculated automatically.
   - Click Add Charge Schedule to create a new schedule. Select the patient's primary or secondary insurance from the Plan field. Note: An insurance policy must be entered into the Patient Record before it can be selected here.
   - Edit an existing charge schedule for the Amount being paid by the insurance company, the Frequency and Charge Amount for subsequent charges, and the Next Charge Date. The # Chgs Remaining and Remaining Balance fields are recalculated automatically, as well as the guarantor's portion of the contract.
4. Click Save Contract. You are prompted to submit a Pre-Authorization claim to patient insurance.
5. Click Submit. A Pre-Auth claim is generated and added to the Claims Management screen.

Note: It is advised that you wait for the claim responses and then enter the associated Pre-Authorization Reference #s in the claim details before activating the contract.

When the contract is activated, Sensei Cloud generates an initial claim for services.

Cancelling the Previous Contract

After the new COT contract is activated and the claim is generated, you can remove the previous claim from the patient's Claims Management window (Patient > Insurance).

Note: When the COT claim is cancelled, the record is removed. If you want to maintain a record, you can select Print Claim to save it as a PDF file before cancelling/removing it.

For more information, see How to Manage Insurance Changes to an Ortho Contract.