Step 6

Training Video 
 

After completing the Patient Registration section, the next step in the patient visit process is Claim Entry.  Post all fee tickets contained in the Claim Entry section of the workbook.
        
   SEE THE “REMINDERS” and “SAMPLE OF CLAIM ENTRY FORM” IN THE WORKBOOK!        
   Following are the page numbers for each Claim Entry section:


 Prime Smile Dentistry pg 1051
 Prime Smile Dentistry A pg 517
 Prime Smile Dentistry B pg 589


Select the Claim –F1 to enter each fee ticket (claim). 

Review the Buttons
It is important to become familiar with and understand the functionalities of the buttons in Claim –F1.  The buttons are:
 

Add: Select this if you want to add this next claim to a patient other than the one listed in the top blue bar.  In other words, you are working on a new patient and need to Select Patient at the beginning of your claim entry.  After you have retrieved your patient, its defaults display.

Add for Active Patient: Select this if you want to add this claim to the patient listed in the top blue bar (which is considered your active patient).

Find for Active Patient: Select this if you want to view or update a claim for the patient listed in the blue bar (active patient).  You can also make changes/updates to this claim and click the Save button.

Find: This enables you to perform a search for an existing claim for any patient.  You can also make changes/updates to this claim and click the Save button.

Import: Not applicable.

 
 
Review the Tabs
There are seven tabs across the top of each claim.  The first three tabs contain the necessary information to complete your ADA J400 form.
 

 1.     Claim: Contains treating and billing dentist; insurance information; and claim preauthorization #.

 2.     Charges: Enter all procedures.

 3.     Additional Info: Contains missing teeth, claim dates and accident information, if provided.

 4.     Insurance: View the patient’s current payer and update ID numbers.

 5.     Activity: Shows transactions for this claim.

 6.     Notes: Not applicable.

 7.     Documents: Not applicable.

 

How Many Claims Per Patient?
It is important to verify the number of claims your assignment requires.  This information is located in the third column on the Patient Listing report in the workbook.    

  Following are the page numbers for the Patient Listing Report:


 Prime Smile Dentistry pg 1051
 Prime Smile Dentistry A pg 517
 Prime Smile Dentistry B pg 589

  

Add a New Claim to a Patient
Before assuming you need to Add a claim, it is important to verify the number of claims your assignment requires. 

To add a claim to a patient, click the Add or Add for Active Patient button.


1.    If you click the Add button, you must immediately click the Select Patient button and search for the desired patient.

 



2.    If you click the Add for Active Patient button, the patient name that is listed in the top blue bar will populate in the 1 Claim tab.
                
 
 
Find an Existing Claim
You can retrieve an existing claim to fix errors.  To find a claim, click the Find or Find for Active Patient button.

 

 


1.    When you click the Find button, the Claim Selection Window displays.  You can search by the partial or full last name in the Patient Last Name field.  Now click the Search button.  If this patient has multiple claims, a selection box displays for you to click on the correct date of service claim.

 
1 Claim Tab

Most of the previously entered patient information will default here.  Double check the information that does default, and complete the remaining fields.

 *    Should be defaulted from the initial Patient –F2 entry.

**   Needs to be completed with claim information provided in the workbook .

1.     Claim Complete: All claims will save as Complete, unless when you click the Save button, an information screen informs                   you that your claim is incomplete and asks if you would like to continue to save as “incomplete.”  If you choose to save your  
       claim as incomplete, you must remember to get the appropriate information and enter it in the incomplete claim, and then
       reselect Claim Complete - “Yes” and click the Save button.  A claim complete “NO” results in a score of 0 (zero).

2.     Claim #: Auto-fills.

3.     Type of Transaction: Defaults to proper setting as Statement of Actual Services..

4.     **Select Patient: When you are adding a claim, you will need to select your patient here and then search for the patient.  Once
        selected, the defaults from the patient registration process will populate.
5.     *Select Treating Dentist: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1 Patient
        tab. 

6.     *Select Billing Dentist: This should default from the treating dentist field.

7.     *Select Primary/Secondary Insurance: The insurance information will populate if already entered properly during the patient
        registration process.  If the payer information does not default here, then return to Patient –F2 and complete the required payer
        information (primary insurance under the 2 Insured tab; secondary insurance under either 2 Insured tab or 3 Other Insured
        tab).  Then go to 4 Misc. Info tab, select B, and check the Save button.

8.     Form Version J400: The version number of the claim.   

9.     **Predetermination / Preauthorization #: If an authorization number is given on the fee ticket, enter it here.

  


2 Charges Tab

 

Place your cursor in the Procedure Date field to start entering the claim information.  Press Tab on the keyboard to continue to the next field. 

 All the following fields are described and need to be completed:

  1.     Set Rows: Count how many charges you will post and enter the number here.

  2.     Charges, Credits, Prev Bal, New Bal: The Charges is the sum of all Total Charges for this claim. 

  3.     Procedure Date: Enter the date of service.

  4.     POS: Defaults to the proper office code.

  5.     Area of Oral Cavity: Enter if information is provided, but not required on the ADA J400 claim.

  6.     Tooth System: Defaults to the proper system code JP used for this exercise.

  7.     Tooth Numbers or Letters: Type or select with the down arrow the tooth numbers or letters when provided on the superbill. 

  8.     Tooth Surface: Type or select with the down arrow the surface letter when provided on the superbill. 

  9.     CDT: Type or select with the down arrow the procedure code as listed on the superbill.

10.     Description: The description of the procedure will default. 

11.     Total Charges: The price of the procedure will default.   

12.     Status: Select the option based on whether the insurance payer is electronic or paper.

 

 

3 Additional Info Tab

 

 1.     Missing Teeth Information (Box 34): Click the number of tooth (teeth) missing when provided on the health history form.

 2.     Number of Enclosures (Box 39): Enter number of enclosures if provided.

 3.     Print Signature on File in Box 36 and 37: Defaults yes to print signature.

 4.     Box 40 - Box 44: These fields are not relevant to these exercises.   

 5.     Treatment Resulting from (Box 45):  Click the proper box to indicate if injury or accident.

 6.     Date of Accident (Box 46): Enter the date of accident (Box 46) if box 45 is checked.

 7.     Auto Accident State (Box 47): Enter the states abbreviation in which the accident occurred. 

 8.     Remarks (Box 35): Enter any remarks pertinent for claim to be processed.


 

 5 Activity Tab

 The Activity report lists the activities for all charges on this claim only.  This is a good way to confirm postings (both charges and EOBs) and aging.



Click the List Activity button.    The report will display for you to view, or you can Print this activity report.

 

Save Your Work

After completing the 1 Claim tab, 2 Charges tab, and 3 Additional Info tab, it is time to save the claim.

 

 
If you don’t want to Save your work, click the Close button.