Entering an Insurance Payment

Insurance payments are entered from the patient’s Transaction screen.

They can also be entered directly from the Past Due Insurance Claim Report.

When you enter an insurance payment from the Transaction screen, you have two choices.

• You can enter the insurance payment code under the Code column by entering the insurance payment code.
• Or you can right click on the insurance claim line (e.g., CP-Sent to Blue Cross Blue Shield) and select Enter Insurance Payment from the popup menu.

The following is an explanation of how to enter an insurance payment from the Code column on the Transaction screen when the insurance pays either the same as the estimated portion or less than the estimated portion.

Start from a blank line under the Code column on the Transaction screen.

• Click on the  Code icon at the top of the Transaction screen and the Service Code list will appear. You can also press [F9] or double click with the mouse.
• Select a Service Code category button, either Pri. Ins. Pay or Sec. Ins. Pay.
• Select the insurance payment code to add to a patient Transaction screen by clicking with the left mouse button. There are separate codes for primary and secondary payments.
• Click on OK.
• You can also type the insurance payment code number or office key word on a blank line under the Code column.
• The current date is automatically entered under the date column for payments.
• Enter the amount of the insurance payment.
• Tip: Enter a Y in the cursor movement and the Fee window will automatically open for you to enter in the amount of the payment.
• Press [Enter].
• The Insurance Payment Distribution window will appear. The amount of the insurance check is shown under Amount Remaining.
• Click to mark the box “Include Patient Balances” if you want to include treatment with zero estimated insurance. This will allow you to link insurance payments to that treatment, as well as to update the insurance plan.
• Click on the treatment line to link the insurance payment to that treatment.
• Note: Linking an insurance payment to lines of treatment will stop it from tracking on the Past Due Insurance Claim Report.
• Click OK to apply the payment to the treatment.
• If an insurance did not pay what MOGO had estimated, MOGO will ask, “Do you want to clear the insurance balance for the selected treatment and add it to the patient’s balance?” Click on Yes and the estimated amount of insurance that is remaining for each line of treatment will be shifted to the patient portion.

You will also have the option to update the insurance plan. When you update the insurance plan, you are updating for everyone with the same employer, insurance company and group number. The next time you enter this treatment for a patient with the same insurance plan, the insurance estimated amount will be accurate. MOGO will give you the option to update for the “Coverage” or the “Maximum”.

• If you update by clicking on “Coverage”, you are updating by a percentage of your usual fee. For example, the insurance may pay 80% of your fee.
• If you click on “Maximum”, you are updating by a dollar amount. In other words, it is the maximum amount the insurance will pay.
• By clicking “No” the insurance plan will not be updated.

If there is secondary insurance MOGO will ask, “Would you like to claim to secondary insurance now?” This question is asked when you close the patient Transaction screen. If you answer Yes, you will return to the ADA form screen so that you can process the secondary insurance claim form.

If the insurance payment does not pay for the treatment that was submitted, you can select the treatment that was not covered in the Insurance Payment Distribution window and enter $0.00 for the distributed amount.

• MOGO will ask if you would like to clear the estimated insurance amount and add it to the patient portion. Personal patient payments could then be linked to this patient portion.
• You will also be asked if you would like to update the insurance plan. If the insurance did not pay because the patient is out of remaining yearly benefits, you will not want to update the insurance plan. You will only update the insurance plan when you want to update the information for everyone with the same insurance plan.
• If the insurance did not pay because the treatment is not a covered service, you will update the insurance plan to the Coverage % (not the Maximum).
• The Distribution Detail window for the treatment will show that the insurance payment amount distributed to the treatment was zero. This will be helpful when you are discussing the balance with the patient at a later date. You can right click on either the treatment or the payment to see the Distribution Detail window. Tip: You may want to enter more information regarding this claim in the patient’s Notes for future reference.

If there is only one treatment on the insurance claim and payment was denied, you can still link a zero amount to that treatment.

• Enter the insurance payment as usual with a zero in the Fee window.
• Double click on the insurance payment code to open the Payment Distribution window.
• Select the treatment and the Insurance Payment Linking window will show a zero as the amount.
• You will also be asked if you would like to update the insurance plan. You will update the insurance plan to the Coverage % (not the Maximum) so that it does not estimate coverage the next time the same treatment is entered.
• Click [OK].
• The Distribution Detail window will now show a zero amount linked to the treatment.

You can also enter an insurance payment from the Transaction screen by clicking with the right mouse on the insurance claim code (e.g., CP-Sent to Blue Cross Blue Shield) and select Enter Insurance Payment from the popup menu.

• Select the claim code (e.g., CP-Sent to Blue Cross) by clicking with the left mouse.
• Click with the right mouse to open the popup menu. Select “Enter Insurance Payment”.
• The Insurance Payment window that opens will display the description of the insurance payment code, the Provider name, current date, and the total estimated insurance amount for the selected claim.
• The bottom of this screen will list the Claim Items. You cannot select from this list since it is for reference purposes only.
• You can retype the amount if needed in the Amount field. There is a gray box at the Provider field if you need to select a different Provider. You can also click on the arrows to change the payment code and date if needed.
• After you enter the correct amount of the insurance payment in the Amount field, click [OK]. The Distribution window that opens will only contain the treatment for this claim! It will include treatment with zero estimated insurance.
• Distribute the insurance payment as usual.

You can also follow the above steps to enter an insurance payment from the Past Due Insurance Claim Reports in the To Do List.

When you right click on an insurance claim code and select Enter Insurance Payment, the distribution window will include treatment that has zero estimated insurance. This will allow you to quickly link an insurance payment and update the insurance plan even when there is no estimated insurance portion!

If you enter an insurance payment on the Transaction screen by typing your insurance payment code, you will see an option to “Include Patient Balances” at the bottom of the insurance payment distribution screen. If you mark this option, it will include treatment with zero insurance estimates.