How to Work With the Patient Ledger – Carestream Dental

Charges and payments are posted to the Patient Ledger during the checkout process following an appointment. When you select the patient from the Checkout Queue, you are prompted to post charges (Post New Charges window) and take payments (Post New Payment window) based on the procedures performed during the appointment.

You can also access the Patient Ledger at any time by selecting Patient tab > Financials > Ledger.

The ledger displays the patient transactions, balance, and Patient Share and Insurance Share (plus any write-offs) amounts (Estimations are based on Insurance Plan Allowance tables or Ortho Contract responsibilities). To sort the transaction list, click on the column heads.

Note: Orthodontic practices have additional buckets in the ledger banner, including: Contract Balance, Current Balance, and Total Balance (i.e., the sum of the Contract Balance and Current Balance). See How to View and Manually Adjust the Insurance and Patient Share Estimation for more information.

A payment plan icon is displayed at the top of the ledger when the patient has at least one active payment plan. See How to Create a Payment Plan for more information.

Select a transaction line item to view additional details. To adjust or remove charges, select a transaction, and then select Adjust This Charge. For more information, see How to Adjust or Remove Charges on the Patient Ledger.

To filter the list by transaction type:

To change the transaction type, select All Types, and select one or multiple options from the Transaction Type drop-down list.
Click Save, and the transaction list narrows to the relevant line items.
Click Reset to restore the transaction list to the full list.

To search for a specific transaction, enter information, such as a service date or transaction amount, into the Search Transactions field, and the list narrows automatically as you type.

Note: Sensei Cloud enables you to customize the Ledger by color-coding transaction types. For more information, see How to Color-Code Ledger Transactions.

Select Hide Ledger Comments to hide manual or automatic claim event ledger comments. See How to Create and Use Ledger Comments for more information.

Under the Actions menu, select from the following options:

New Charge: post new charges.
New Payment: post new payments.
Post Completed Work: post charges for previously completed work.
Adjust Balance: adjust the balance, such as for discounts, write-offs, and refunds.
Add Ledger Comment: manually add a comment to the patient's ledger.
Note: You can choose whether to include the comment on printed statements and account history. See How to Create and Use Ledger Comments for more information.
Create New Claim: create a new insurance claim.
Note: This option is active only when unbilled procedures exist, and it displays the number of eligible procedures.
Print Billing Statement: print a billing statement as a .PDF file.
Print Account History: print account history as a .PDF file.

Multi-Location Practices

Multi-location practices can also filter the patient's ledger by Location. When filtered to one or more locations, the total balance information adjusts to show the balance for the selected location(s) on the top line with the overall balance displayed below it.

Note: When there are balance discrepancies across practice locations (i.e., the patient has mixture of debit and credit balances across locations), a piggy bank icon is displayed in the Total Due KPI (or Total Balance KPI for patients with orthodontic contracts).

When the ledger is filtered to one or more locations, the Print Billing Statement and Print Account History options are disabled. Reset the location filter to All Locations to regain access to these functions.

For location-specific statements, you can use the Accounts Receivable screen (Location > Financials > Accounts Receivable) or the Statement Worklist (Location > To Do > Statement Worklist).

Note: The Guarantor For and Guaranteed By ledger views do not support location-based filtering and those balances do not reflect any filtering applied to the main ledger view. See Guarantor Ledger View for more information.

Orthodontic Contract Transactions in the Patient Ledger

Additional contract information is included in the patient ledger descriptions of orthodontic contract transactions. These transactions include the contract name in parentheses in the description to help distinguish them in cases where the patient has multiple contracts or there are patients who share the same guarantor.

Additional descriptive details are included to help clarify the ledger, statements, and account history. For example, certain orthodontic contract transactions (e.g., downpayments) include a Pt. indicator for patient transactions, while transactions funded by insurance are indicated by Ins.

Orthodontic contract transactions that might appear in the patient's ledger include:

Initial contract charges
Discounts
Periodic charges
Downpayments
Pre-pay adjustments
Contract closure adjustments
Contract closure write-offs

Guarantor Ledger View

The Patient Ledger provides the ability to view and bill accounts by guarantor.
When multiple patient accounts are combined under one guarantor, you can print a billing statement or account history for the group.

When a patient is a guarantor for another patient or multiple patients, their ledger displays a Guarantor For option alongside the default Patient Name ledger option. When the patient is their own guarantor and is not responsible for any guarantees, only one ledger view is available.

The number of guarantees is indicated in parentheses next to Guarantor For. Select the Guarantor For option to display the combined balance overview that the guarantor is responsible for, as well as the individual patient balances for the guarantor and guarantees.

When a patient is not their own guarantor, the patient ledger displays a Guaranteed By option alongside the Patient Name ledger option.

Select the Guaranteed By option to view the combined balance overview for the patient’s guarantor, as well as details regarding the patient’s current balance.

Note: Detailed transaction line items are not included in the Guarantor For or Guaranteed By view. To see a patient's individual transactions, open the Patient Name ledger.

A payment plan icon is displayed next to the patient name if they have an active payment plan.

The Actions menu within the Guarantor For and Guaranteed By ledger views is reduced to three options:

New Payment
Print Billing Statement
Print Account History

Note: In some cases, there may be both Guarantor For and Guaranteed By ledger views if the patient is a guarantor for other patients, but is guaranteed by an individual other than themselves.

To edit the guarantor for a patient:

Navigate to Patient > Patient Record.
Select Edit Patient Record, and then scroll to the Responsible Parties section.
Select the Guarantor indicator (green star), next to the appropriate party, to assign a guarantor. The star is filled with green when selected or filled with white when deselected.
Note: You can also check Is Self-Responsible to make the patient their own guarantor, or select Add New Responsible Parties, if the responsible party is not already included in the patient’s record.
Click Save Patient.

See How to Add a Patient Record for more information.

Post Charges from the Ledger

To post charges:

Under Actions, select New Charge. The Post New Charges window is displayed.
Use the Search Procedures field to find and select a procedure.
Verify or correct the indicated Location, Provider, and Amount.
When required, enter the Tooth/Quad and Surface for the procedure.
Repeat Steps 1-4 for additional charges.
Click Post Charges & Bill Ins.

For more information, see How to Post Charges and Payments From the Patient Ledger.

Post Payments from the Ledger

Insurance payments are deducted from the Insurance Due amount, and patient payments reduce the Patient Due amount.

To post a payment from the Ledger:

Under Actions, click New Payment. The Post New Payment window is displayed with the patient's balance.
If the payment is a split payment intended to cover charges for multiple patients, such as family members who are connected, use the Search field to select one or more connected patients.
In the Amount Paid field:
--Enter the payment amount next to the applicable patient.
--If you want the payment to be allocated to an existing payment plan, select the checkbox next to Select Payment Plan, and then use the drop-down list to select one of the patient's active payment plans. See How to Create a Payment Plan for more information.
Verify or correct the Location and Date fields.
Note: If the payment is being allocated to a payment plan, the location defaults to the location that the payment plan is for and cannot be changed.
Select a Payment Type from the list. If you select Insurance - Check, Insurance-Credit Card, or Insurance-EFT, you are prompted to select a claim, and the Claim Number is automatically added to the transaction details upon posting. If you select a Payment Type of Credit Card, Check, Insurance - Credit Card, or Mobile or Online, a Payment Subtype option is displayed.
Note: The transaction line in the ledger for insurance payments includes the Insurance Payer, Claim #, and Date of Service (DOS).
If applicable, select a payment subtype from the drop-down list.
Note: For example, if your payment type is Mobile or Online, you can specify a subtype such as PayPal or Zelle, etc. The subtype is displayed in parentheses next to the payment type in the transaction line on the patient ledger.
Use the Reference and Comments fields as needed for additional information.
Verify that the Payment Amount is correct.
Click Post Payment. The credit is added to the patient ledger.

Important: When you are signed up to use ePayments Secure for Sensei Cloud, the posting process is different. For more information, see ePayments Overview, and the ePayments Secure for Sensei Cloud Getting Started Guide in the Carestream Dental Institute.

Print Billing Statement

You can print a billing statement for an individual or print a billing statement for a group, which includes all the balances for which a guarantor is responsible, from the patient ledger.

For more information, see How to Print a Billing Statement and How to Print a Group Billing Statement.

Print Account History

You can print an account history for an individual or group from the patient ledger.

To print an individual account history:

Select the Patient Name.
Select Print Account History. A report is generated for the selected patient.

To print a group account history:

Select Guarantor For or Guaranteed By.
Select Print Account History. A Guarantor Account History report is generated for the entire group, with entries sorted by patient.

For more information, see How to Print a Patient Account History.

Adjust the Calculated Estimation for Insurance and Patient Shares

You have the ability to view open claims that are contributing to the patient's Insurance Share and Patient Share amounts, as well as make any changes to these amounts, from the patient ledger.
See How to View and Manually Adjust the Insurance and Patient Share Estimation for more information.