Creating an Advanced Claim (US)

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Description

This quick guide demonstrates how to create an Advanced Claim, and breaks down the different areas where specific information can be added to it.

Contents

The following sections are covered in this quick guide:

• Section 1 - Access and Overview
• Section 2 - Line Items
• Section 3 - Advanced Options
• Section 4 - Tooth Summaries
• Section 5 - Related Causes

Steps

Section 1 - Access and Overview

1. With the correct patient at the top of the Sidekick, click Billing.

   

2. In the Billing module, right click the invoice, and click Claims.

   

3. In the Claims dropdown menu, click Advanced Claim.

   

4. The Advanced Claim dialog box opens. At the top it indicates the patient the claim is for.

   

5. To change the target insurance plan, click the insurance plan, then click the desired plan in the dropdown list.
   Note: This is typically used if the patient has more than two insurance policies.

   

6. The Billing as provider can also be changed. Click the provider to change it to someone else.
   Note: Click Setting Up Provider and Clinic Information to Successfully Send Claims with DentalXChange to learn more.

   

7. The default facility can be changed as applicable. Click Office, and select the correct facility in the dropdown list.

   

8. If procedures require an attachment, click None beside Add attachments and select the desired option.

   

Section 2 - Line Items

About: Line Items allows a code to have a replacement or initial placement indicator. It is also where ICD-10 and Medicare modifiers can be added.

1. Click Line Items.
   
2. To add a placement indicator, click the applicable code and then click Select code.
   
3. If the procedure code requires an Oral Cavity Designation, click Add and select the correct option.
   
4. If the code requires an ICD-10 code, click Add ICD-10 Codes(s) and type the applicable diagnosis code(s).
   

Section 3 - Advanced Options

1. Click Advanced Options.

   

2. If a predetermination has been sent, click the Predetermination Identification Number field and type the number.

   

3. A narrative or other information (up to 88 characters) can be added to the claim by clicking the Note field.

   

4. If services are for orthodontic purposes, click the checkbox to indicate it and fill in the treatment duration details.

   

Section 4 - Tooth Summaries

1. Click Tooth Summaries and then click Add.

   

2. Enter the Tooth number and indicate if the tooth is Missing or To Be Extracted.

   

Section 5 - Related Causes

1. Click Related Causes and then click Add. This is used for treatments resulting from accidents (liability).

   

2. When all information has been added, click Manual Claim to print or Send to Batch for electronic submission.