SoftDent: What Are the Steps Creating a Medical Claim?

Document created by chriscornett Employee on Jul 13, 2017
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Problem:


How To Submit Medical Claims in Softdent, including: Selecting the HCFA Medical Form; Setting an Insurance Plan to Print the HCFA Form; Adding a CPT Code; Linking an ADA Code to a CPT Code; Linking the CPT Code to One or More Diagnosis Codes; Posting Medical Codes to a Patient

 

Solution:

 

SOFTDENT Software provides the ability to submit medical claims. In order to submit to medical, an ADA code must first be linked with a Medical CPT code and a Diagnosis code.

To assign
medical codes to a patient their insurance plan type must be set to "Medical " and they must have medical insurance assigned under their patient and guarantor insurance information. Also their insurance plan needs to be printing claims on a HCFA certified form, generally these forms are pre-printed and offices will need to procure the necessary pre-printed forms. The ADA procedures that are to be performed will need to be linked to CPT codes, which inherently need to be linked to Diagnosis codes. SOFTDENT Support does not have a list of the necessary CPT nor the Diagnosis codes. When the ADA codes are posted to a patient who has been set up correctly, the CPT and Diagnosis codes will appear linked to the ADA code automatically.

 

Perform the following sections in order:

 

Selecting the HCFA Medical Form

 

1. From the main menu bar, click Insurance.
2. Click Select Insurance Forms.
3. Select and note one of the 10 positions and use the drop-down arrow to select the necessary medical form. Form #177 (CMS -1500) is commonly selected, but this may differ depending on the state’s requirements.
4. Click OK to close the 'Select Insurance Forms' window. 

 

Setting an Insurance Plan to Print the HCFA Form

 

1. From the main menu, select List.
2. Select Ins. Plan.
3. Type the name of the Insurance Plan into the ‘Find’ field and press on the keyboard.
4. Double-click on the desired insurance plan.
5. The insurance plan information will open. Select the red "Claim Filing" tab.
6. Place a check in the box labeled "Print Claim No".
7. Enter the "Form No" drop down arrow in position 1 - 10 as previously selected.
8. Select OK and close the "Insurance Plan" window.

 

Adding a CPT Code

 

To link the desired ADA code to the corresponding CPT code you will need to add a CPT code to the ADA, CPT, and Diagnostic Codes List:

CPT Codes are numbered from 10000.00 Through 99999.99. When adding a code falling within this range, SOFTDENT Software will automatically set it as a CPT Code.

 

1. From the main menu bar, select List.
2. Select ADA Codes.
3. Highlight any code in the list and then click Add to add a new CPT code.
4. Enter the CPT code number in the “Code” field of the Add ADA / Transaction Codes window. 
5. Enter the desired code description.
6. Select the "Type of Service" from the "Medical Information" section of the window.
7. Select the "Class of Service" from the "Code Class" section. 
8. The default code classes are

  • Anesthesia
  • Surgery
  • Radiology
  • Pathology / Lab
  • Medicine
  • Consultation

9. If any diagnosis codes are available, select a "Diagnostic Code" from the field labeled "Default Diag Codes".
10. Click OK once the desired information has been entered. Click Close to close the current window.

 

Linking an ADA Code to a CPT Code

 

1. From the main menu bar, select List.
2. Select ADA -> CPT.
3. Enter the ADA code number that is to be linked in the field labeled "ADA".
4. Click Add.
5. Enter the CPT code to which the ADA code is to be linked into the field labeled "CPT Code".
6. Click OK to link the code.

 

Linking the CPT Code to One or More Diagnosis Codes

 

1. From the main drop down menu, select List.
2. Select CPT -> DIAG.
3. Type the CPT code and press <Enter> on the keyboard.
4. Click Add.
5. The “Diagnostic Codes for CPT code” window will be displayed. Click the drop-down arrow.
6. Perform one of the following options:

  • Double-click an existing diagnosis code from the list
  • Press <Enter> on the keyboard and click Add to add in a new diagnosis code. If adding a new diagnosis code, enter the ICD9 code and a description and click OK, then click Close. Then double-click the newly created diagnosis code when the listing is displayed.

7. Click OK when the “Diagnosis Codes for CPT code” window is displayed.

 

Posting Medical Codes to a Patient


1. From the main menu bar, select List.
2. Select Patient
 

Make sure the patient has been assigned a medical insurance plan.


3.
Highlight the patient, and select Transaction from the patient list toolbar.
4. From the Transaction toolbar, select Add
5. Type the linked "ADA Code" in the code field and press<Enter> on the keyboard.
6. A new field labeled “Link” will open linking the CPT code along with the Diagnostic Code to the ADA Code.

 

Associated diagnosis codes can be selected from the “Diagnosis Codes (ICD-9)” drop-down listing if they are not automatically populated. These diagnosis codes will only be automatically populated if they have been entered (automatically or manually) within the patient’s “Codes” information tab. When diagnosis codes are selected from this list and the procedure is posted to the patient’s ledger the message, “Do you want to set this patient’s default Diagnosis Codes based on the ones entered for this transaction?” is displayed. Click Yes to set the currently entered diagnosis code as the patient’s default diagnosis code.

 

7. Click OK and close the Transaction Window.
8. From the Express Bar, select Submit to Insurance.
9. A "Date of Service" dialog box will open, select OK if the Date of Service is correct, or change the date of service "Start Date" and "End Date" to the desired dates.
10. A message will appear letting you know you are "Processing a Linked Claim", click OK.
11. A window will open allowing you to select the Medical and Dental Insurance Companies. Enter the alphabetical character (Generally A or C) associated with the insurance primary dental and primary medical companies and click OK
12. The claim will open allowing you to enter more information by selecting either the information tab, status tab, or enter W/C accident information. 
13. If this is a preauthorization, under the "Information Tab", check the box labeled "Preauthorization". Select OK and close the claim window.
14. Send the HCFA form electronically, send the form to the batch, or print the form.

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