Medical Insurance

[stravers]

I have had a few patients lately ask me to send a pre-treatment estimate to their medical insurance.  I don't see an option in the treatment plan to send a pre-determination to Medical Insurance. It only give me the option of primary and secondary dental insurance. Does anyone have advice on how I can do this? Thanks in advance.

[sonyap]

You can send a medical claim from Practice Works, but I don't think the HCFA-1500 can be used for pre-determinations.  Usually you have to call the insurance company's pre-auth line.

[cabaa99]

Any instructions on how this is done? We got a claim denied by dental b/c needs to be submitted to medical and looking for how to do this without going the manual route...

[debi_peterson]

You have to add the appropriate medical and diagnostic codes in PW (Lists > Transaction Codes). Then you have to also have the patient's medical insurance linked in their clipboard. If they have medical insurance listed, and you post medical/diagnostic codes, it will automatically print a medical form (kind of). You have to load the red HCFA-1500 form into the printer, and the data will print in the correct boxes.

[jdowner]

Just to add a little to what @debi_peterson said as well.

One thing to keep in mind, PracticeWorks will only trigger to print to the 1500 form if all the codes that are a part of the claim/checkout are from the codes you added to the medical code list.  If even one Dental CDT code is a part of that group of codes on the claim, it will print as a dental claim. 

Unfortunately, @cabaa99, it will still be a manual process for medical codes through us.  You have to have the pre-printed HCFA (CMS) 1500 form, as we only fill in the blanks on the medical form. We also do not have the native capability to send medical claims electronically. 

[cplummer]

We currently use a 3rd party software to send pre-d's and claims to medical insurance. It is some what of a pain, but has seemed to work pretty well for our office. Another option you could look into is some insurance companies allow you to file medical online... hope this helps for now!

[robertangus]

Sarah,

   There currently is not a way to create a Medical Claim Pre-Treatment estimate within PracticeWorks. This is something Development is aware of and may take a look at for future releases. I'm tagging Jeremy Uriz on this as well. juriz‌ You may want to check out his thread on the upcoming updates here and I know he's looking for feedback for future updates as well.