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Change Claim Procedure's Provider for Insurance Income Allocation Purposes

Some offices want to associate a procedure's insurance income to a general provider, yet retain the treating provider association on the procedure itself. The purpose of this would be to allocate the insurance income to the general provider instead. To do so, you need to be able to change the provider on a claim procedure without changing the provider on the procedure. To make this work, there are specific setup and workflow steps to follow. They are outlined below.

For Example:

  • Dr. Jones is the treating provider on an orthodontic procedure for Office A.
  • Office A wants the insurance payment for this procedure to be associated to a provider called 'Ortho', not Dr. Jones.

Warning: In most scenarios, the provider on the Claim Procedure matches the provider on the associated Procedure so that production and income match. In fact, when you change a procedure's provider, by default the matching claim procedure's provider also changes. It is possible to have mismatched providers, but there are issues you need to be aware of and additional work involved.

  • Be extra dilligent to prevent accidental provider mismatches. Anytime you change the provider on a procedure and want the provider on the claim procedure to match, you will have to change it manually once a procedure is attached to a claim.
  • Allowing a mismatch will mean that production on a procedure and the insurance income on that same procedure might not match in reports when ran for specific providers.
  • Until claim procedures are attached to a claim, the claim procedure provider will always match the procedure provider. This is by design to prevent accidental provider mismatches.

Instructions
Setup:

  1. In Chart Module Preferences, turn off the preference 'Procedure provider overwrites claim procedure provider when attached to claim'.
  2. For users who are allowed to change the provider on a claim procedure, assign the Permission 'Claim Procedure Provider Edit When Attached to Claim'.

Change the Provider: For this to work, each claim procedure must already be attached to a claim.

  1. Treatment plan the procedure and, when ready, mark it complete.
  2. Create the claim.
  3. From the Edit Claim window, open the claim procedure (double-click on the procedure).
  4. Change the provider and click OK.

Audit Trail: Any time the provider is manually changed on a claim procedure attached to a claim, a log entry will be added to the Audit Trail for permission ClaimProcClaimAttachedProvEdit that states the procedure code, a short description of the carrier, the old provider abbreviation, and the new provider abbreviation it was changed to.

Notes:

  • If you change a procedure's provider and want the provider on the claim procedure (attached to a claim) to match, you must change it manually.
  • If the preference 'Procedure provider overwrites claim procedure provider when attached to claim' is not off and you attempt to change the provider, the change will be logged in the audit trail, but the provider on the claim procedure will revert to match the procedure.

Troubleshooting
Problem: Claim procedure provider changes are being logged in the audit trail, but the provider is being reset after clicking OK.
Solution: Make sure the preference 'Procedure provider overwrites claim procedure provider when attached to claim' is unchecked.

Problem: Claim procedure provider changes are not being logged in the audit trail, and the provider is being reset after clicking OK.
Solution: Check to make sure the procedure is attached to a claim. Provider changes made before the procedure is attached to a claim will be overwritten.

 

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