In a Procedure, at the bottom, is the Financial tab.
This tab shows insurance estimates and payments, patient payments, attached adjustments, and any procedure discounts.
Insurance Estimates and Payments
Each entry row is a Claim Procedure. Estimates are usually automatic based on the Insurance Plan. If an estimate doesn't look right or is missing, first make sure the insurance plan is set up correctly.
- Each procedure can have only one estimate per insurance plan.
- The status column indicates the status of the claim. Est indicates estimates that are not yet attached to a claim.
- If you create a Treatment Plan before entering the insurance plan, you may need to update fees to affect estimates. See Fees Update.
If the insurance plan is correct but you still need to make a change, there are some situations where you can manually edit an estimate.
- Override the estimate: Maybe you got a pretreatment estimate back from insurance or you have a fee schedule to follow. Double click on the estimate row, then enter a different amount for Insurance Estimate. You can also override percentages, allowed amounts, copays, etc.
- Do Not Bill to Ins: Check when you do not want to send the procedure to insurance. If, on the Procedure Code, this procedure is set up as Do Not Usually Bill to Ins, the box will be checked by default.
To manually add an estimate:
- Click Add Estimate.
- If multiple insurances exist for the patient, select the insurance to add the estimate for.
- Show plans for family which are not in use by the current patient: Click to show all plans for the patient, even those that are currently dropped.
- Once insurance has been selected, or if only one insurance exists for the patient, the Edit Claim Procedure Window will open.
- Enter the estimate information and click OK.
Adding an estimate to a procedure on an insurance plan that already has an estimate will open the existing estimate.
Payment splits in Patient Payments that are attached to this procedure will list. Double-click to edit.
Procedures with paysplits attached cannot have their status changed from completed unless the total of paysplits attached equals zero.
Adjustments can only be added to completed procedures.
- Add New Adj: Create a new adjustment.
- Link Existing Adj: Attach an existing adjustment to this procedure. Adjustments not attached to a Paysplit or procedure are listed. Select an adjustment from the Adjustment Picker window and click OK.
Note: The procedure's clinic and provider must match the clinic and provider of the adjustment. If the provider and clinic do not match, the procedure value will not be updated and the adjustment will be considered a separate charge when a payment is applied.
To edit an adjustment attached to this procedure, double-click the item in the grid.
TP Procedure Discount applied at the treatment plan level show, or a specific dollar amount can also be entered. The logged-on user must have the Adjustment Create permission to add or edit the discount. When the procedure is set complete, discounts will show as adjustments.