cancel
Showing results for 
Search instead for 
Did you mean: 
tmbircher
Canine II

Claims Question

Jump to solution

Hello! We have been noticing that sometimes when we electronically batch for example: Periodic Exam and Prophylaxis, Softdent will seperate the two and batch them seperately on 2 claims. Why?

0 Kudos
Reply
9 Replies
Moderator
Moderator

Re: Claims Question

Jump to solution

This occurs in cases where a patient has had a hygiene procedure and another procedure, however the hygienist is set to be their own doctor on insurance forms. By selecting the appropriate doctor on insurance forms, both procedures will print on one claim form.

This may also happen when a patient has had procedures done by more than one doctor and those doctors are set to be their own doctor on insurance forms. In cases such as this, two claim forms will be generated for procedures done by each provider.

  1. Click List in the main menu bar.
  2. Select Providers. The Provider List window is displayed.
  3. Double-click on the patient's hygienist.
  4. Make certain the appropriate provider is selected in the field labeled "Dr on Insurance Forms". This is usually the doctor the hygienist typically works with.
  5. Click OK to save the changes.
  6. Cancel the original claims.
  7. Reprocess insurance, both procedures will now be on the same claim form.
drcavola
Premolar III

Re: Claims Question

Jump to solution

Margaret,

I am curious as to the details of these phenomenon you describe.  I've seen it too - more times than I'd like to admit.

Please do me a favor and look at the transactions of each of those claims.  I would bet that one of those two claims have NO transactions listed.  For example, using your periodic exam and prophy.  I suggest that the issue is not as Aymen suggests, with two claims, one of the exam and one of the prophy.  

I've been working with this issue with a very high level tech ... and he's having a hard time duplicating.

Let me know ... and thanks.

0 Kudos
Reply
enspire
Premolar I

Re: Claims Question

Jump to solution

I was just able to pinpoint how it happens, at least in our system.  Under the list of providers, if you have a Dr. in the "assign collections to" spot, it will actually print two claims.  When I did not have a Dr. there, it printed it on one claim and the on the claim listed the Dr. who did the exam.  I think if you don't have an "assign collections to" it just uses the Dr. who did the exam or the one assigned to that patient. 

We do have multiple Drs. and 8 hygienists, so our settings may be a little different than others.

Let me know how this worksSmiley Happy

Moderator
Moderator

Re: Claims Question

Jump to solution

enspire‌ 
hey Tonya 
i found this more detailed breakdown for the causes of this issue and the checklist for a solution 


- The Production (DR) or Collection (D$) providers are set incorrectly on the posted procedures being submitted.
- Hygiene procedures are being submitted, but are not marked as "Hygiene Code" in their ADA code information window.
- The "Dr. On Ins Forms" is not set correctly for a provider who performed one of the procedures.


if you can check these points that might cause this to happen 

  1. Verify the posted transactions have the correct DR and D$ specified.  The D$ should be the doctor collecting on the procedure, while DR should be set to the provider who performed the procedure.

    2. If any of the procedures being submitted are hygiene codes:
    - click ListADA Codesdouble-click the hygiene code > verify "Hygiene Code" is checked.  You may also verify this box is unchecked for non-hygiene procedures being submitted.

    3. Confirm the Production and Collection providers for the procedure.  Most practices typically have a doctor who collects on all work performed, or doctors who collect on their own work and specific hygienists' work.  Click List > click Providers > double-click a production provider for the procedures.  If they're a hygienist, the "Dr. On Ins Forms" will need to be set to the doctor who appears on claims in their stead.  If they're a doctor, they may be set as their own "Dr. On Ins Forms", or the head doctor may be set.  For the procedures to be generated on a single claim, the "Dr. On Ins Forms" needs to be set to the same doctor; if one provider has one doctor set and the other provider has another, SoftDent will generate two separate claims, as procedures performed by two or more doctor cannot be submitted on the same claim.

    4. After verifying the above and making any necessary corrections, open the patient's Transactions ledger > click Outstanding Ins >highlight the existing claim > click Cancel Claim > click Yes to delete the canceled claim.  To resubmit the claim, return to the patient's transactions ledger, click Submit Insurance, and follow the prompts as usual.  The new claim will be generated with the information updated by making any changes to the above
enspire
Premolar I

Re: Claims Question

Jump to solution

I figured this out, by the way I mentioned above.  Just trying to be helpful to the original poster, not sure if her issue was resolved. 

Moderator
Moderator

Re: Claims Question

Jump to solution

enspire‌ , sorry didnt see that , yeah just adding some extra info about  that subject for others  

drcavola
Premolar III

Re: Claims Question

Jump to solution

No Ayman, that's not what is happening with in our office.  It's a little bit more complicated than that.  And, yes, I have already checked the settings, codes and such.  There is not an issue with any of our settings.

We just had the issue creep up again at the end of our work day on Thursday.  I ran the unsubmitted insurance claims and found for one of our younger patients, three of the four procedures got on one claim (#106759), and the other (four bitewings) did not get on "any" claim.  That's the one that showed up as unsubmitted only.

For some reason, Softdent is not linking all those 4 procedures together.  And, I know you're thinking it's because of the provider.  But ... it's not because 2 of the 3 transaction items were from the same hygienist, or provider.

0 Kudos
Reply
tmbircher
Canine II

Re: Claims Question

Jump to solution

Thanks!

0 Kudos
Reply
tmbircher
Canine II

Re: Claims Question

Jump to solution

Sorry all! I have been viewing the comments and haven't replied in a timely manner! I  haven't noticed it again but I think I know why it happened. I was changing the hygienist's provider ID BEFORE submitting to insurance. Ever since I started changing the ID after the appt is sent to insurance, it stopped. Thank you!

0 Kudos
Reply