Claim Procedures ( claimprocs )

In a Claim, double-click on a procedure.

Alternatively, in the Procedure - Financial Tab double-click an estimate.

A claim procedure (claimproc) is used for the following purposes:

In a typical situation:

  1. While treatment planning, a procedure is created.
  2. A claimproc is automatically added to the procedure to keep track of its estimated insurance portion. Change the estimate by changing the claimproc.
  3. When the claim for the procedure is created, the claimproc links the procedure to the claim.
  4. When viewing the claim detail, all procedure estimates and payments are stored in the claimproc rather than with the procedure. This allows you to send an unlimited number of claims for each procedure and to have very fine control over all estimates and payments for each claim.
  5. When receiving a claim, it can be itemized by procedure or entered as a total payment.

Change the information as needed, then click OK to save. The logged-on user must have the correct security permission to edit write-offs and write-off estimates.

Ins Plan: The insurance plan and subscriber. Claimprocs are always associated with one insurance plan whether they are an estimate or attached to a claim.

Status: The status of the claim procedure.

Payment Tracking: Document information about the payment of the procedure. Useful to track why payment was rejected. Customize options in Definitions: Claim Payment Tracking.

Provider: Provider attached to the claimproc. By default, this is the provider who performed the procedure, but can be different. This provider will be assigned to any insurance payment. Click [...] to change. The provider can only be changed when the status is set to Not Received. See: Claimproc Provider.

Clinic: The associated clinic. Only visible if Clinics is turned on.

Pay Entry Date: The date the related insurance payment was entered. Used to track account aging. Only displays after an insurance payment has been received.

Payment Date: Can be edited until attached to an insurance check. Once attached to an insurance check see Finalize Insurance Payment to edit payment information.

Procedure Date: The date the procedure was performed. Used to track annual benefits used.

Description: The procedure code description.

Claim: Indicates if this claimproc is an estimate or has been attached to claim. If part of a claim, the following information shows:

Do Not Bill to Insurance: Only used when the claimproc is an estimate. Indicates that this claimproc will remain an estimate and never be attached to a claim. Estimate information is hidden when this box is checked.

Estimate Information: Located at the top right. Changing information will not change the patient's balance.

Note: Overrides can be entered into the white boxes to the right of select fields. Be aware that manually entering overrides will not fully recalculate insurance coverage. For example: adding a missing coverage percentage will not result in a missing deductible being added. Whenever possible, it is best to correct coverage information here: Change Insurance Plan Information.

Claim Info: Claim information is in the lower right. If the claimpoc is still an estimate, the lower portion will not be visible. Once attached to a claim, the lower section can only be edited from within a claim.

Attached to Insurance Payment Plan: This box is automatically checked if this claimpoc's insurance payment is attached to an insurance payment plan. You can also check this box manually, if, for instance, you enter a payment first, then decide to create a payment plan. See Insurance Payment Plans.

Blue Book

When Blue Book is enabled, the Blue Book Log button is visible. Click to see the history of the blue book fee for this procedure code.

The history of the fee will display. As allowed amounts are entered, or manual fees change, they will be logged here.