Changing claim details

You can view and edit claim details.

To change claim details

1. On the Unsent Claims page or Sent Claims page, clicktap a claim to display the Claim Detail window.

   Tip: You can also display the Claim Detail window from the patient's Insurance Claims page or the patient's Ledger page.

   Unsent Claim

   

   Queued, Sent, Printed, Rejected, or Received Claim

   

2. Modify the details as necessary on any of the following tabs:

   • Procedures

     The Procedures tab displays the associated procedures.

     

     You can clicktap the Add Procedures button to display the Add Procedures window and add unattached procedures to the claim.

     You can also remove attached procedure(s) from the claim.

     Important: Procedure changes are automatically applied to pre-post write-offs.

   • General

     The General tab displays the billing and rendering provider information, the pay-to address, patient information, subscriber information, and payer information.

     

     You can change the Billing Provider and/or Rendering Provider by selecting a different provider in the Name field as necessary.

     Note: Only providers who have access to the location where the claim was created are available.

     Important: If you change the billing or rending provider from a non-contracted to a contracted provider, the Create contracted write-off when claim is saved toggle displays. You can set the toggle to Yes to create a contracted write-off.

     Also, if the selected Rendering Provider has been designated as a locum tenens treating provider in their user account, the Locum Tenens Treating Provider toggle is set to Yes by default. You can change the state of the toggle if necessary; however, the locum tenens treating provider is not required for most claim form versions. Currently, this setting affects only printed 2024 ADA claim forms, and the carrier's selected Printed claim format must be the 2024 version to include this information on printed claims.

     You can also update the claim's Subscriber and/or Payer information to the patient's latest insurance information by clickingtapping the Refresh button beside the outdated section.

     Note: If there are any changes to the Subscriber and/or Payer information, a icon displays beside the outdated section and the outdated field is highlighted in orange. You can clicktap the icon to view more information on the changes.

   • Claim Info

     The Claim Info tab displays the name of the Referring Provider, the predetermination Reference Number, Orthodontia information (months remaining; and total months, the default value of which is calculated automatically, based on the placement date and remaining months specified, if the claim was created for orthodontic treatment), the Place of Service for the associated treatment, Accident Information (type, date, and state), and Remarks For Unusual Services (notes for the insurance carrier for this claim only).

     

     You can enter or change any of the information.

     Note: Only the first 80 characters of Remarks for Unusual Services are submitted electronically.

   • Attachments

     The Attachments tab displays the patient's perio exam and the images from the patient's Document Manager that are attached.

     

     You can add and remove attachments if the claim has not been submitted (does not have a status of Queued, Sent, or Accepted) or rejected (has a status of ADDINF, NEARERROR, or so forth):

     • To add an image attachment, clicktap Add From Document Manager. In the Add From Document Manager window, select the checkboxes of the images that you want to attach, and select a classification/type for each selected image (if necessary, you can change the classification/type later by selecting a different option from the Classification/Type list on the Attachments tab). ClickTap Done.

       

     • To attach a perio exam, clicktap Add Perio Exam to view a menu that lists the dates of the patient's perio exams, and clicktap the date of the perio exam that you want to attach.

     • To remove attachments, select the checkboxes of the attachments that you want to remove or select the All checkbox and clicktap Remove Selected. When prompted to confirm, clicktap OK. The image is removed from the claim but not from the document manager.

     Notes:

     • The Add From Document Manager button is not available if the payer is a non-supported carrier (a carrier that was manually added to your practice database not from the list of supported carriers that Henry Schein maintains; it has payer ID of 06126).

     • When you add a document from document manager, the action is logged in the Audit Log page as a Patient type with "Document [filename] was viewed" in Details.

     • The Add Perio Exam button is not available if the payer is a non-supported carrier or if the patient does not have any perio exams entered in their record.

     • Only .jpg/.jpeg files from a patient's document manager are valid for images that you want to attach to claims. Files in a non-valid format do not appear for selection. You can attach only one perio exam to any given claim. You can have up to a total of 10 attachments per claim.

   • Status/Notes

     The Status/Notes tab displays the created and sent (if applicable) dates of the claim, the original reference number, and claim statuses.

     

     You can enter or change the Payer Claim reference # provided by the payer. If necessary, under Specific Payer Requests, clicktap Replace Claim to resubmit the claim with the changes, replacing the original claim, or Void Claim to void the claim (enter a zero payment). You can access a resubmitted or voided claim from the patient's Insurance Claims page. Also, you can type a message in the Note field and clicktap Add Note to add a custom status update. Some statuses are entered automatically, such as a status message with an NEA number if the claim has attachments.

3. Complete one of the following:

   • ClickTap Save, then Cancel to save and close the window.

   • ClickTap Submit to save the changes and submit the claim.

   • ClickTap Resubmit to save the changes and resubmit the claim.

   • ClickTap Print, then OK on the message that displays to create the claim as a PDF file that you can print.