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doctom4300
Premolar III

Tracking pre-determinations

I'm trying to correctly handle pre-determinations so that we can run a report that will show us which pre-d's have not yet received a response from the insurance company.

Currently, we create a treatment plan and then file it with insurance. When we get the pre-d back from the insurance, we contact the patient. If they schedule, no problem. If they don't schedule, what do we need to do to mark the claim as received back from insurance? I thought about just deleting the pre-d claim, but then it'd look like we never filed with treatment plan with insurance.

Thanks for your help.

Brenda

13 Replies
Community Manager
Community Manager

Re: Tracking pre-determinations

shanableeann do you have any suggestions?

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leeann
Canine II

Re: Tracking pre-determinations

When you get the pre-auth back from the insurance > open the patients treatment plan and click Add > then enter code 2.20 (Pre-Auth Received) and enter the amount the insurance said they would pay > change the Type to Estimate > click the drop down arrow for claim no. and select the pre-Auth claim < you can enter a note if you like and then click OK > click Yes for final payment > follow remaining prompts. This will remove the pre-Auth claim from the outstanding claims. 

To get a report of pre-d claims that have not been returned you can run the outstanding claims by company report. Go to Reports > practice management > Insurance Reports > outstanding claims by company and uncheck all boxes except the boxes for the Pre-Auth claims.  List claims older then __ days, (enter your number) and then click OK.  This will give you a report for all outstanding Pre-Auth claims older than the number of days you specified.

In addition since you changed the type on the transaction in the treatment plan to Estimate you can run a report for Transactions for a Period ( REPORTS > ACCOUNTING > TRANSCTIONS FOR A PERIOD) and use E as the code type in the report setup and get a report of all Pre-Auths that you got back from the insurance in a specified date range. 

doctom4300
Premolar III

Re: Tracking pre-determinations

Thanks Lea Ann - that works perfectly!

Since we've never added the 2.20 code before, the report generates quite a few (ok, a LOT) of outstanding pre-auth claims. Is there any way to restrict the report to claims older than X but younger than Y? Or is there a way to batch mark all those old pre-auths as received?

Thanks again.

callton
Premolar I

Re: Tracking pre-determinations

Code 2.20 is Metlife Insurance pmt in my computer, not pre-auth received.  I'm sure that was a manually added code from years ago.  Will it work if I create a new code for "Pre-auth received" using a number in the 2.0s?  I have always just deleted the claim once a pre-auth was in (I know it was submitted by the claim number in the claim status field).  

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doctom4300
Premolar III

Re: Tracking pre-determinations

Just a quick note to apologize for misspelling your name, Lee Ann!

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leeann
Canine II

Re: Tracking pre-determinations

At this time I don't know of a way to generate a report for a specified date range. If you go to LIST > CLAIMS, you can see all the outstanding claims in your SoftDent.  All the Pre-Auth claims will be blue with ** in the TP column.  You can delete them from this list and it will remove them from the outstanding claims report. 

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leeann
Canine II

Re: Tracking pre-determinations

Carrie

It will work if you use a code between 2.21 and 2.89 for your Pre-Auth Received.

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leeann
Canine II

Re: Tracking pre-determinations

You're welcome

Lee Ann Hebert | Certified Trainer

US Training Department

leeann.hebert@carestream.com

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callton
Premolar I

Re: Tracking pre-determinations

Great - thanks, Lee Ann!

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