Ortho Auto Claims

Use the Ortho Auto Claims Tool to generate periodic orthodontic claims.

In the Main Menu, click Tools, Ortho Auto Claims.

Ortho Auto Claims are useful when a carrier wants a claim submitted for the initial procedure, plus periodic claims based on a set frequency (i.e., Auto Proc Period) instead of per visit.

Note: The Auto Ortho tool cannot be used in conjunction with Ortho Case.

Before setting complete the initial orthodontic treatment, make sure to review Ortho Setup and the carrier's Ortho settings (Insurance Plan, Ortho tab).

Setup Requirements:

How it works:

  1. Once the initial orthodontic treatment procedure is set complete and a claim is sent, periodic claims are subsequently flagged for auto-generation based on the carrier's Auto Proc Frequency, Ortho Auto Proc, and Ortho Auto Fee.
  2. The initial claim is scheduled for the first day of next calendar month (e.g., 03/01/2023).
    • If the setting Wait 30 days before creating first automatic claim is enabled in Insurance, Ortho tab, the first claim date will be postponed until the first day of the month at least 30 days out.
  3. Once the current date is at or after NextClaim date, the claim is listed in the Claims to be Created grid.
  4. Generate the claim using the Ortho Auto Claims Tool.
  5. Subsequent claim dates are determined by the Auto Proc Frequency after an Auto Ortho Claim is created (e.g., if a claim is created on 03/01/2023 and Auto Proc Frequency is quarterly, the next claim date is calculated as 06/01/2023). The NextClaim date will always be calculated to the first day of the month the claim is due to be sent.
  6. Claims will continue to be flagged for auto-generation until the total treatment time (i.e., Total Tx Time) is reached or the NextClaim date is manually removed.

Ortho Auto Claims Window

Clinic: Select a clinic from the dropdown to filter by patients assigned to that clinic.

Claims to be Created Grid: Patients due to send an Auto Ortho claim for the current month or past due will appear in the grid. Click a column name to change sorting. Numerical sorting will use the same logic as alphabetical sorting. Rather than 1, 5, 10, users will see 1, 10, 5.

Generate Claims: Select patients and click to generate Auto Ortho claims. See Generate Periodic Ortho Claims using the Ortho Auto Claims Tool below.

Select All: Select all rows (i.e., patients) in the grid.

Close: Exit the Ortho Auto Claims window.

Set Ortho Preferences

The following items must be set up to use the Ortho Auto Claims Tool.

In Ortho Setup:

Set Insurance Plan preferences

In the Edit Insurance window, Ortho tab, specify the carrier's claim preferences. Any changes made will affect all patients using the plan.
See Insurance Plan for details.

Schedule the Patient's Initial Treatment Procedure

As usual, schedule the patient's initial treatment appointment with the corresponding orthodontic placement procedure.

  1. At the time of treatment, set the appointment/procedure complete. Doing so will populate the next claim date for the patient based on insurance plan ortho frequency setting. This will be the date for the first Ortho Auto claim.
  2. Check the Auto Ortho tab to verify that dates and fees are accurate.
  3. Manually create and send a claim for the ortho placement procedure.

Generate Periodic Ortho Claims using the Ortho Auto Claims Tool

Each month, check the Ortho Auto Claims Tool to see which periodic claims are due to be sent. The next claim date will always be the first of the month.

Claims that meet the ortho auto claim criteria will list alphabetically by last name:

To create Ortho Auto Claims:

  1. Select the claims to automatically generate.
    • Highlight specific claims to generate.
    • Optionally filter claims by clinic using the Clinic dropdown.
    • Click Select All to select all claims.
  2. Click Generate Claims. A confirmation message will show. Click Yes to continue.
  3. Another message will indicate when the process is complete and the number of claims generated. Click OK.

Close the Auto Ortho Claims window, then view the Account Module. The claim will show with a waiting to send status. The Auto Proc Code in the claim (e.g. D8670.auto) will also show in the patient's account. To send, see Send Claims.

Determining the Next Ortho Claim

There are two places to view when a patient's next ortho claim is flagged for generation with the Ortho Auto Claims Tool.

The Next Claim Date is automatically updated each time the Ortho Auto Tool creates a claim. Manually change or clear the date from the Ortho Patient Setup window. This can be useful if a periodic claim needs to be skipped or claims need to be stopped altogether.

A few hints:

Providers on Claims

The treating provider on the claim depends on the billing provider for the practice.

Claim Payments

When generating Auto Ortho claims, consider where claim payments should be entered: on the initial procedure's claim or on the auto-generated claim.

To only allow staff to enter claim payments on the initial procedure's claim, check Consolidate Ortho Insurance Payments in Ortho Setup. Then enter any installment payments as Supplemental Insurance Payments on the original claim and receive auto-generated claims as zero payment claims.