How to Create an Ortho Contract

 Related Training
Setting Up Orthodontic Contracts Recorded Class

Sensei Cloud enables you to create and manage contracts for a patient's orthodontic treatment. You can create as many contracts as needed over the course of a patient's treatment. You can also create contracts with varying down payment amounts and payment schedules, and print them for approval. 

If a guarantor pre-pays their portion in full, you can create a contract that schedules charges to the applicable insurance plan throughout the course of treatment.

Once saved, the contract is placed in a Pending state; it can then be edited, activated, or cancelled. You can also print a Truth in Lending disclosure statement, which you can scan and upload to Patient Files.

Once activated, the initial contract charges are posted to the Patient Ledger, which tracks both the total (overall) balance and current balance. Periodic contract charges are automatically posted to the ledger, based on the contract’s schedule and updates to the patient’s current balance.

To create an Ortho contract:

1. From the Patient tab, select Financials > Contracts. 
2. Under Actions, select New Contract. The Contracts window is displayed, with defaults entered for the Location and Provider in the Contract Summary section.
   
3. Enter a Description for the contract, such as Phase I, Phase II, or Full Treatment. This value is reflected in contract-based ledger transactions.
4. In the Treatment field, select from the list to more specifically identify the course of treatment covered by the contract (such as Full Tx Braces, Invisalign, etc.), or start typing in the field. If the option you want is not in the list, you are prompted to create it.
5. For Treatment Modality, select Mechanics or Aligners.
6. Use the Bonding/Tx Start Date field to enter the date of service on which planned treatment is scheduled to begin or current treatment began.
   Note: If the date is more than six months past, you are prompted to confirm, as this may affect insurance billing. You can plan future treatment in a pending contract state, but when activating, the date must not be in the future.
7. Enter the Est. Months of Tx. or the Est. Completion Date, and the other field is calculated automatically. 
8. Select the appropriate CDT code for Initial Billing, and any additional initial CDT codes in the Addl. CDT for Initial Claim field. All codes are posted to the Patient Ledger upon contract activation and included on the initial service claim.
   Note: Ortho-specific CDT codes (D8000 series) are displayed by default, but any CDT codes can be entered by searching and selecting.
9. Enter the Contract Fee and any Discount Amount and Type, if applicable. The Contract Total is calculated automatically.
10. Scroll to the Contract Charge Schedules section. The Guarantor is entered automatically from the patient record.
    
11. Use the Downpayment Amount, Charge Amount, and # of Charges fields to enter how and when the contract will be paid by the guarantor. These fields work together; changing any one adjusts the other two. Use the sliders to find the best combination to suit the office and patient.
12. Select the Frequency for which the specified charges will post.
    Note: If you select Pay in Full in the Frequency field, the guarantor's full contract amount is recognized as a down payment when the contract is activated. This prevents future, scheduled contract charges from being posted to the ledger, but still allows for insurance-based charges to post on their scheduled dates.
    Note: Active contracts cannot be marked Paid in Full, but you can pre-pay the guarantor’s portion of the contract balance to realize some or all of the guarantor’s remaining balance as current. For more information, see How to Enter Ortho Contract Pre-Payments.
13. Enter the First Charge Date (current or future date) for which charges will be levied for this charge schedule.
    Note: The Charge Last Day of Month checkbox becomes active when the last day of the selected month is entered in this field.
14. If the guarantor has insurance on record, the Add Charge Schedule link is displayed. Click this link to display another set of entry fields to enter the insurance plan's charge schedule.
    
15. Select the patient's Plan and specify the Amount anticipated to be covered by insurance, the Charge Amount and Frequency in which insurance is to be billed. The insurance amount is automatically subtracted from the guarantor's portion, and the guarantor's schedule (# of charges) is recalculated accordingly. 
16. Enter the CDT for COT Claims required by the patient's insurance for continuation of treatment claims. You can also use the Addl. CDT for COT Claims field for additional codes.
17. Verify the Proposed Payment Schedule in the next section. To adjust the schedule details, return to the previous sections.
    Note: A separate schedule is displayed for the guarantor and each insurance plan used in the contract.
    
    Note: If multiple insurance plans are being used for this contract, click Add Charge Schedule to display another set of entry fields for the next insurance plan. An insurance policy must be added to the Patient Record before you can select it in the contract.
18. Click Save Contract. A dialog is displayed prompting you to activate the contract. If the contract has an Insurance Schedule, you are prompted to create a Pre-Authorization claim. Select Activate Later to save the contract in a pending state and prompt the preparation of Pre-Authorization claims. Select Activate Now to realize the down payment and begin applying the charge schedule defined in the contract.
    Note: You might also be prompted to enter more information, such as anatomy and CDT codes to submit pre-authorizations. For more information, see How to Generate Pre-Authorizations for Ortho Contracts.

Important: The contract is not active until you activate it. An Active status is required for posting, balance transfers, claims, and so forth, to occur.  

Using Automatic Payments

Orthodontic practices using the Sensei Cloud ePayments Secure service can set up automatic, recurring payments as part of an Ortho contract. You can add automatic payments to new and existing contracts. For more information, see How to Use Automatic Payments for Ortho Contracts.

Activating a Pending Contract

When you are ready to begin the work for a pending contract, select the contract from the list, and click Activate Selected Contract. When the contract is activated, a link is added to the Treatment Tracker in the banner of the patient’s Orthodontic Clinical Summary. The value in the Treatment field in the contract is displayed as the Current Tx. The Bonding/Tx Start Date and Est. Completion Date are used to calculate the Tx Track indicator, which provides a summary of the projected treatment time remaining.
Note: If the patient's treatment is already in progress, contract activation automatically ends the current treatment and starts treatment tracking based on the currently-active contract.
Note: The Bonding/Tx Start Date for the contract must be the date you are activating the contract, or a previous date on which treatment began.

The initial charges are automatically posted to the patient's ledger. When you activate a contract that includes an insurance plan, an initial insurance claim is created automatically.

Print and Save

See How to Print and Save an Ortho Contract.

Orthodontic Contract Transactions in the Patient Ledger, Statement, and Account History

Additional contract information such as the contract name is included in the descriptions of orthodontic contract transactions (e.g., initial charges, discounts, periodic charges, downpayments, etc.) in the patient ledger. The patient statement and account history also include information to clarify orthodontic contract transactions, such as the remaining contract balance. 

See How to Work With the Patient Ledger and How to Print a Patient Billing Statement for more information.