In Dentrix G7.5, a new feature was added allowing you to post a partial insurance payment to a claim. With this new feature, you can post a payment to a claim without closing it, so you can still track it for future additional payments.
As in previous versions of Dentrix, you still have the option to split a primary claim in order to post a partial insurance payment if an insurance plan doesn’t pay for all procedures on the claim. (That way you can still track the unpaid procedures.)
Here are a couple of scenarios when I would recommend using these different features.
Making a Partial Insurance Payment
Posting a partial insurance payment is an ideal way to handle orthodontic claims in your practice. Typically, an orthodontic claim is paid by insurance with an initial down payment, then the remaining orthodontic maximum is paid over the course of the patient’s treatment. For example, if the patient has an orthodontic maximum of $1000, the insurance plan may pay an initial down payment of $500, and then the remaining $500 would be paid over the estimated course of treatment of twelve months.
In previous versions of Dentrix, if you simply posted the initial $500 payment, the claim would be closed and would no longer appear on the Insurance Aging Report. This would mean you would lose the ability to track the claim. Also, it would appear that the entire account balance would be owed by the patient, which would be confusing for both the patient and your office team to calculate how much of the account balance the patient actually owed. By posting a partial payment, the claim will remain open, and you can still track it on reports. Also, patient and insurance balances will still be calculated accurately. Additionally, you have the option when creating Billing Statements to skip accounts with a partially paid claim, which could help to avoid any patient confusion.
Splitting a Primary Claim
Splitting a primary claim is another way to track unpaid or partially paid claims. I would suggest using the split claim feature if the insurance plan paid for one or more procedures on the claim, but not all procedures. For example, you may have filed a claim for a crown (D2740) and a core build up (D2950), and the insurance plan paid for the core build up but denied the crown because they are requesting additional information. In this case, you could split the primary claim, which would allow you to post the payment for the core build up, while keeping the claim for the crown open and outstanding. That way you will be able to continue to track the claim for the crown, and the patient portion of the account balance will continue to be calculated accurately.
The new partial payment feature in Dentrix G7.5 is an exciting new feature that will help your practice handle specific situations, such as orthodontic claims. There are other situations when the split primary claim will be the appropriate tool to use. Either way, these features both give you the ability to continue to track outstanding insurance claims to be sure your office is getting paid by insurance properly.
To learn more about features in Dentrix G7.5, and prepare your team for the upgrade, watch this on-demand webinar recording.
By Charlotte Skaggs
Certified Dentrix Trainer and The Dentrix Office Manager columnist
Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for over 20 years and is a certified Dentrix trainer. Contact Charlotte at [email protected].