Insurance - benefit to patient

[kat710]

We have an insurance company that we are no longer in network with and they send the payment directly to the patient.  The insurance company said they do not send us a statement or any information as to whether they paid the patient, etc. 

I have changed the inurance plan tab on some of these to benefits to patient, but apparently that doesn't do much.

I need the claim to go to the inursance company. Then I need it to bill the patient and in many cases these patients have double coverage, where the secondary insurance needs to be triggered.

Can someone tell me the proper set up in the system and how it will work?

Thank you

[mbrown]

@kat710 @Anon 

Is the prompt to delete the claim in Softdent transactions screen or in the Electronic Services screen? We have several insurances that send payments to the member and we've been manually attaching $0/blank insurance check payments to the claims to close them. Surely there's a better way, yes?

[lindamoseley]

To trigger the prompt to delete the claim go to the insurance plan record. 

List>Insurance Plan. Go to the Claim Filing tab on the plan. 

Check the box for Benefits to Patient. 

You will still create the claim as usual. Immediately after the claim has been created, SoftDent will prompt you to delete the claim. The claim will be still appear in the eServices batch or print batch until it has been transmitted or printed. 

"Deleting" the claim sounds scary. But it is not truly deleted. What is happening is SoftDent is marking the claim as completed. That way it does not appear in your outstanding claims reports. 

[mbrown]

Thanks! I think I understand but just to check: when the ECS capable button is selected, the "Insurance Plan does not require a printed form. Delete claim now?" check box doesn't  display. Is there some other setting to alter?

We're SD version 17.1.1.

[lindamoseley]

This must be the message you are getting after you select to "print" the claim. 

This is triggered to appear because the "Print Claim Form" box is not checked on the insurance plan set up window on the Claim Filing tab. 

To test this I created a claim and went through the process to file the claim. I chose to send to "Print" instead of "Electronic". I checked the box to delete the claim. I then double-checked the completed claims for the patient. (Transactions>Completed claims). This claim was showing there. However, this claim was not in the print batch because we told SoftDent not to print. So there was nothing to send to the insurance company. 

If you chose to submit the claim electronically instead, SoftDent is not asking to delete the claim as expected. I will investigate this further. 

[mbrown]

It'll be so helpful to figure out a solution. Currently, our insurance coordinator manually attaches a $0 insurance check to close each claim. It takes quite a long time. 🙃

[mbrown]

@lindamoseley @tshaw

[Anon]

You are on the right track. First collect all the money from the patient at checkout. You have the correct switch enabled on the plan. You will be prompted to submit the claim, when you transmit the claim electronically you will be messaged that claim has benefits to patient and will ask you to delete the claim which is what you want because you won't receive the payment or EOB to be aable to close the claim and you don't want it as open insurance because it can delay their statement depending on the ICM method you have enabled for that account. When you print the claim to paper it will ask to delete the claim, delte the claim. You will still be able to submit secondary but again you won't have any eob to submit it unless patient provides it to you.but you can give them a copy of the printed submitted claim and they can mail it on their own with their EOB from primary. This is the best approach.Please contact me directly if you have any further questions.