Changing claim details

You can change details of a primary claim that has not been paid: procedures, diagnosis (ICD-10) codes, billing and rendering providers, payer information, additional claim information, attachments, and status notes. Also, the patient and subscriber information appears for your reference.

Note: On secondary and tertiary claims, you cannot change all the details that you can for primary claims.

To change claim details

1. Click (or tap) a claim on one of the following pages:

   • The Unsent Claims page.

     

   • The Sent Claims page.

     

   • A patient's Insurance Claims page.

     

   • A patient's Ledger page.

     

   The Claim Detail dialog box appears.

   Unsent Claim

   

   Queued, Sent, Printed, Rejected, or Received Claim

   

2. Change the details as needed on any of the following tabs:

   • Procedures

     The Procedures tab displays the associated procedures and conditions.

     

     Modify the procedures on the claim as needed:

     • To add procedures procedures to the claim, click (or tap) Add Procedure. The Add Procedures dialog box appears and lists procedures that have the same date of service as the procedures already on the claim. Select the check boxes of the procedures that you want to add, or select the check box in the column header to select all procedures. Then, click (or tap) Add Selected.

       

     • To remove procedures from the claim, select the check boxes of the procedures that you want to remove, or select the check box in the column header to select all procedures. Then, click (or tap) Remove Selected. If you attempt to remove all procedures from the claim, a message appears and asks if you want to delete the claim and any associated payments and adjustments. Click (or tap) Delete to confirm the deletions.

       

     Note: If an automatic write-off adjustment was posted for the claim, when you change the procedures, the adjustment is replaced or deleted as needed.

     For the procedures on the claim, the associated diagnoses appear. You can have up to four ICD-10 codes per claim. Modify the diagnoses as needed:

     • To remove ICD-10 codes, click (or tap) the corresponding Remove buttons .

       

       Note: Removing ICD-10 codes from a claim does not affect the corresponding procedures. All diagnoses remain attached to their corresponding procedures as currently posted in the patient's ledger and progress notes.

     • If you have less than four ICD-10 codes, to add an ICD-10 code to the claim, select a diagnosis from the Select a diagnosed condition list. Only the diagnoses attached to the claim's procedures (as currently posted in the patient's ledger) are available for selection. If there are two, three, or four ICD-10 codes, select the one that you want to be the primary diagnosis.

       

   • General

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

     

     Change the Billing Provider and/or Rendering Provider as needed. Only providers who have access to the location where the claim was created are available.

     Note: If the patient's insurance plan details have changed since the claim was created, a yellow warning symbol appears on the General tab, and next to Payer. Click the Refresh button to update the payer information.

     

   • Claim Info

     The Claim Info tab displays the name of the Referring Provider, the predetermination (pre-authorization) 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).

     

     Enter or change any of this information as needed.

     Note: Only the first 80 characters of Remarks for Unusual Services are submitted electronically even though the box allows up to 151 characters.

   • Attachments

     The Attachments tab, displays the patient's images from Dentrix Ascend Imaging, images from the patient's document manager, the patient's perio exam, and the patient's clinical notes that are attached.

     

     Note: To reduce delays or non-payments from insurance carriers, Dentrix Ascend alerts you when, according to NEA guidelines, supporting documentation is recommended for any procedures on a claim. An orange warning icon and a message with the applicable procedures and recommended attachment types appear when claim attachments are recommended. For a secondary (or tertiary or quaternary) insurance claim, a warning message includes a recommendation to attach the EOBs from the corresponding primary (and/or secondary and/or tertiary) claims before submitting the secondary (or tertiary or quaternary) claim.

     

     You can ignore a warning and submit the claim without the recommended attachments.

     Important: Ignore an attachment recommendation only if you are certain that the payer does not require supporting documentation for the procedure.

     Add and remove attachments as needed:

     • To attach an image from Dentrix Ascend Imaging, click (or tap) Add Image. In the Add from Imaging dialog box, click (or tap) a procedure with the correct date of service to view the corresponding images. Select the check box next to the procedure name to attach all the images in that section to the claim, or individually select the check boxes of images that you want to attach to the claim. Repeat this process as needed. Then, click (or tap) Add.

       

     • To attach an image from the document manager, click (or tap) Add From Document Manager. In the Add From Document Manager dialog box, select the check boxes 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). Click (or tap) Done.

       

     • To attach a perio exam, click (or tap) Add Perio Exam to view a menu that lists the dates of the patient's perio exams, and then click (or tap) the date of the perio exam that you want to attach.

     • To attach a narrative, click (or tap) Add Narrative to view a menu that lists the patient's clinical notes, and then click (or tap) the clinical note that you want to attach.

     • To remove attachments, select the All check box to select all the attachments, or select the check boxes of the attachments that you want to remove. Click (or tap) Remove Selected. On the confirmation message that appears, click (or tap) OK.

     Notes:

     • The Add Image button is available only if the payer is a supported carrier (a carrier that was added to your practice database from the list of supported carriers that Henry Schein maintains). The payer ID of an unsupported carrier is 06126.

     • The Add From Document Manager button is available only if the payer is a supported carrier (a carrier that was added to your practice database from the list of supported carriers that Henry Schein maintains). The payer ID of an unsupported carrier is 06126.

     • The Add Perio Exam button is available only if the patient has perio exams entered in his or her record and if the payer is a supported carrier (a carrier that was added to your practice database from the list of supported carriers that Henry Schein maintains). The payer ID of an unsupported carrier is 06126.

     • The Add Narrative button is available only if the patient has clinical notes entered in his or her record and if the payer is a supported carrier (a carrier that was added to your practice database from the list of supported carriers that Henry Schein maintains). The payer ID of an unsupported carrier is 06126.

     • You can attach images from a patient's document manager only if those images are .jpg/.jpeg files. You can attach only one perio exam to any given claim, but you can attach a perio exam to multiple claims. If you attach a clinical note as a narrative, Dentrix Ascend automatically converts it to a .jpg file.

     • You can have up to a total of 10 attachments per claim, but the total claim size (claim data and attached files) must be smaller than 15 MB.

   • Status/Notes

     The Status/Notes tab displays the status of the claim, the created and sent (if applicable) dates of the claim, the original reference number, and status notes. Some notes are entered automatically, such as a status message with an attachment ID if the claim has attachments.

     

     If an update for the status of the claim has not been received from the clearinghouse for at least two days, the Refresh Status button is available. To request an immediate update, click (or tap) the button. However, manually requesting an update should not be needed under normal circumstances. If the request results in a status change, the new status appears next to Status, and a note regarding the update appears in the Notes list. Also, the Refresh Status button becomes unavailable, but may become available again after two days without an update from the clearinghouse has elapsed.

     Enter or change the Payer Claim Reference # provided by the payer (to replace or void the claim, the reference number is required). To resubmit the claim with the changes (replacing the original claim), click (or tap) Replace Claim. To void the claim (enter a zero payment), click (or tap) Void Claim. You can access a replaced or voided claim from the patient's Insurance Claims page.

     To add a custom status update, click (or tap) Add Note, enter a message in the Note box, and then click (or tap) the Completed button .

     

3. Do one of the following:

   • To save and close the dialog box, click (or tap) Save and then Cancel.

   • To save the changes and submit the claim, click (or tap) Submit.

   • To save the changes and resubmit the claim, click (or tap) Resubmit.

   • To create a .pdf file of the claim, which you can print, click (or tap) Print and then OK on the message that appears. Use this option only if there are no electronic attachments for the claim.