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cromfs
Premolar II

Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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When we have insurance claims pending but need to delete another insurance plan from the charges when cleaning up the unbilled insurance report, the charges move from Ins due to Pt due even though there are still claims pending.  This should not occur.

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8 Replies
CS Dental Employee
CS Dental Employee

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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Cromfs, please provide more details. You are correct, Win OMS does not move insurance due amounts to the patient when there are still claims pending. The cause may be the ICM selection.
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cromfs
Premolar II

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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Let's say you have an active medical and dental policy.  You need to remove the charges from going to medical.  If you delete the medical plan from the charge, the charge automatically moved to Patient Due even though an active dental claim is still pending.

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CS Dental Employee
CS Dental Employee

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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If you have an active Medical and Dental policy on the patient and would like to remove just the medical, I would do so by editing the transaction. Click on the medical claim under "claim history" box on the right and send to the "garbage can." THEN I would click on "new" on the left side of the edit screen and choose the dental insurance. If this was done then you did it correctly and there is something within the ICM or Insurance Plan that might have caused the "insurance due" to move to "patient due."
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CS Dental Employee
CS Dental Employee

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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“Hi Tara! I’m going to send you a private message with some additional information. Click the envelope on the top right of The Exchange to view.”

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CS Dental Employee
CS Dental Employee

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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I have created a case and will have a WinOMS Support Rep. reach out to you personally to help.

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CS Dental Employee
CS Dental Employee

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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The reason why the balances changes from Insurance Due to patient Due is because of the Insurance Due Calc Method assigned to the patient(s).

When you edit a charge for a patient set to ‘Do not Calculate’ then the balances moves from Insurance Due to Patient Due. Do Not Calculate is used when you want all charge amounts to appear under patient due but the SW will still allow you to add amounts under Insurance during posting.

I did notice that the reverse is not true when the Insurance Calc method is set to ‘Calculate without estimating’ which defaults all charge amounts to Insurance Due. Editing a charge for a patient set to ‘Calculate without estimating’ does not move the balance from Insurance Due to Patient Due.

So the question now becomes, does your office use Allowable Schedules? If you do, then all Patients should be set to ‘Calculate with Estimating’ otherwise they should be set to ‘Calculate without estimating’. Charge amounts will still be set to patient due if the patient has no Insurance but set to Calculate without Estimating.

To update all patients, go to Tables > Practice > Practice Preferences > Insurance Tab and change the method to either Calculate without Estimating or Calculate with Estimating and uncheck ‘Allow Patient Override’, and click OK to save changes. Unchecking this box updates all patients to the selected method.

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cromfs
Premolar II

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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I went to change our settings to Calculate Without Estimating but it was already set to that.  Yet, when we have patients with dual insurance it still automatically moves from Insurance Due to Patient Due if I drag one of the insurances to the trash for a charge.

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CS Dental Employee
CS Dental Employee

Re: Charges should not move from Ins Due to Pt Due when an insurance claim is pending

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Just a quick reply to let you know that I saw your response and will do some more research on the issue.
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