Electronic Claims – Batching
To batch an insurance claim to send electronically, you will follow the same steps as when processing a paper claim. The difference is that the Form Type is selected as “Electronic Claim”.
After changing the Form Type to “Electronic Claim”, you will click on the Print/Send icon. The claims are then batched to be sent to the clearinghouse at a later time.
When you process an insurance form, it will default to the Form Type (i.e., Electronic Claim) that was entered in the Insurance Form field on the Employer/Insurance Plan screen for this plan. In addition, you can select the Form Type when you are processing an insurance claim. Tip: The default insurance Form Type can be selected or changed for all insurance plans from Office Setup on the Insurance Tab.
If the Form Type field on the insurance claim screen does not say “Electronic Claim”, click on the arrow and select.
Due to HIPAA Regulations for Electronic Claims, the relationship choice of “4-Other” is not allowed.
If a paper claim is sent, relationships over “Other” will be marked as “Other” on the claim form.
Relationship choices can also be selected on the Patient Information screen in the Insurance Linking area.
These are the relationship choices in MOGO:
- Other – This choice is not allowed with Electronic Claims. You will be told the claim will be rejected and you will be prompted to select from a relationship list.
- Unknown – This choice is not allowed for Electronic Claims to the primary insurance. Unknown will be accepted in the [Other Coverage] area. You will be told the claim will be rejected and you will be prompted to select from a relationship list.
- Handicapped Dependent
- Significant Other
- Injured Plaintiff – This choice is not allowed for Electronic Claims in the [Other Coverage] area.
- Life Partner – This choice is not allowed for Electronic Claims in the [Other Coverage] area.
The following icons at the top of the claims processing screen are used when claims are sent electronically. Tip: Point to any icon and a tool tips window will describe it for you!
- Print/Send – To batch an Electronic Claim. It is then sent later by you via modem to the Electronic Claim clearinghouse Emdeon (WebMD).
- Options – To mark Student Status, select Treating Dentist, and select the Insurance Payment Option (Signature on File, Payment to Patient, or Blank).
- Electronic claims require a Student Status unless the relationship is Self, Spouse, or Child.
- Student Status is required for a Child who is 19 years of age or older.
- Choices marked under Options are not saved. You must select the Student Status each time you process a claim form.
- View Eclaim – To view the list of Electronic Claims that have been batched and need to be sent.
Electronic claims are batched from the patient Transaction screen as follows:
- Go to the Patient Transaction screen.
- Click on the Insurance icon.
- Click to select the transactions.
- Edit the insurance claim screen as needed.
- Click on the Print/Send icon to batch the claim.
- A message will say “E-Claim file is generated”. Click [OK].
The Patient Transaction screen will now show the following information:
- Dr. will indicate the initials of the provider.
- T# will show a number which indicates how many lines of treatment were on the claim form.
- Surf. will contain the insurance ID number.
- Description will either show CPe (Claim Primary-electronic) or CSe (Claim Secondary-electronic) OR APe (Authorization Primary -electronic) or ASe (Authorization Secondary-electronic).The insurance company name will also be shown.
- Date will be the date the insurance form was processed.
- Code will either show PCsnt if a primary claim was sent, SCsnt if a secondary claim was sent OR PAsnt if a primary pre-authorization was sent, or SAsnt if a secondary claim was sent.
- Fee is the total amount of the treatment of the claim form.
- Est. Ins.1 is the estimated primary insurance portion.
- Est. Pat is the estimated patient portion.
- B will indicate an N for “no” since the insurance claim line is a non-billable code.
- Ins1. Clm on the line of treatment will indicate the date the primary insurance form printed if the claim was sent manually.
Insurance claims and pre-authorizations are tracked in the To Do List under the Treatment Status tab. You can view and re-print previously printed insurance claims as well as electronic insurance claims.
Right click on a past due insurance claim or pre-authorization to open the popup menu. Select “View Claim Form”. The previously claimed form will be sent to the screen.