How to Manage Claims for a Location

 Related Training

Managing Insurance Claims Recorded Class

Use the Claims Management window to manage claims for a location or all locations in a practice.

From the Location tab, select Claims > Claims Management.  The Claims Management window is displayed, listing the claims for the selected location.

For each claim, the Claim Number, Status, D/M (dental/medical), Claim Type, COV (primary or secondary coverage), Provider, Last Updated date, Payer, Plan, Patient Name, and Billed and Paid amounts are displayed. You can sort the list by any of these columns.

Use the Filter List to refine the list by claim or coverage type, status, provider, payer, date created, or aging date range. 

Click the Export Report option to create a .CSV file of the list as it is refined.

Claims that require action display an Alert icon in the Status column. For example, come claim statuses that have alert icons include: Needs Info, Awaiting Attachments, or Invalid Data. 

Note: Click on the claim for more information on what actions need to be taken to transmit the claim.

You can also: 

• Search claims by: Patient, Policyholder, Claim ID, and Procedure codes (CDT code and nomenclature).
• Filter the list by Type, Status, Providers, Payers, Date Created, and Age range.
  Note: The claim Type is assigned automatically when the claim is generated: Svc (statement of actual services), Pre-Auth (request for pre-authorization), COT (continuation of treatment for orthodontic services), Ortho (initial claim for orthodontic treatment).
• Elect to display only claims that are Cancelled, Pending Review, or Awaiting Attachments.

Claim Summary

Select a claim in the list to view the Claim Summary. 

From the Claim Summary, you can:

• View claim details
  
  Note: The Service Location Information section is only visible in the claim details if the selected service location differs from the practice location.
• Enter a pre-authorization reference number
• Edit the Practice Location and/or Service Location for the claim
  Note: This option is only available if the claim is not yet in a completed state (e.g., Printed, Submitted, etc.). Changing the location only affects the claim and not the ledger line items.
• Edit the Provider for the claim
  Note: This option is only available if the claim is not yet in a completed state (e.g., Printed, Submitted, etc.). Changing the Provider only affects the claim and not the ledger line items.
• Edit ICD-10 medical diagnosis codes
• Submit unsubmitted claims
• Print claims
• Apply payments
• Edit additional information
• Update the claim status
• Cancel the claim

Adding a Pre-Authorization Reference Number

You can manually add a pre-authorization number that was received from an insurance payer via a portal, phone call, fax, etc., to both medical and dental insurance claims.

To add a pre-authorization number to a claim:

1. Navigate to Patient tab > Insurance > Claims Management (or Location > Claims > Claims Management).
2. Select the appropriate claim. The Claim Summary is displayed.
3. Click Add Reference #. The Add Claim Pre-Authorization Reference # window is displayed.
   
4. Type the reference number, and then click Save.
   

The saved pre-authorization number is automatically populated on dental and medical claims, including paper and electronic. For printed claims, the pre-authorization number is automatically printed in Box 2 of dental forms, and it is printed in Box 23 of medical forms. 
If you need to edit the pre-authorization reference number, click on the number in the Claim Summary to display the Add Claim Pre-Authorization Reference # window, and then make any necessary changes.

You can also send pre-authorizations for treatment-planned work and record the authorization reference number. See How to Get Prior Authorization for Treatment Planned Work for more information.