Employer Preferences How does it impact my Insurance Claims

1
Employer Preferences - How does it impact my
Insurance Claims?

• We will focus on the ADA 2006 insurance form and
  how the Employer Preferences area determines what
  information is printed on your insurance forms.
• ID Policy Holder By
• Allows you to select the information that will
  identify the Policy Holder of the Insurance and
  will print in Box 15 of the ADA 2006 form.
• Select from
• Social Security Number
• Carrier ID
• Medicaid ID
• Social Security and Carrier ID
• Member ID
• All of the above information can be edited and
  saved in the Edit Person and Edit
  Person/Preferences Window of the Policy Holder

2
Employer Preferences - How does it impact my
Insurance Claims?

• Identify Patient By
• Allows you to select the information that will
  identify the Patient and will print in Box 23 of
  the ADA 2006 form.
• Select from
• Social Security Number
• Carrier ID
• Medicaid ID
• Member ID
• None
• All of the above information can be edited and
  saved in the Edit Person and Edit
  Person/Preferences Window of the Patient

3
Employer Preferences - How does it impact my
Insurance Claims?

• Identify Billing Dentist By
• Allows you to select the information that will
  identify the Billing Dentist or Dental Entity and
  will print in Box 51 of the ADA 2006 form.
• Select from
• Social Security Number
• Tax ID
• Tax ID and Social Security
• Additional identifiers are available to select,
  however, not recommended for use on the ADA2006
  form.
• eClaims users, would want to select either the
  SS OR the Tax ID, but not both
• All of the above information can be edited and
  saved in the Edit Provider/Staff- Identification
  Window of the Provider on Insurance

4
Employer Preferences - How does it impact my
Insurance Claims?

• ID Dentist By
• Allows you to select additional information that
  will identify the Billing Dentist or Dental
  Entity and will print in Box 52a of the ADA 2006
  form.
• Select from
• BCBS
• DEA Reg Number
• Delta Number
• Medicaid
• Medicare
• NPI
• Other Ids
• None
• All of the above information can be edited and
  saved in the Edit Provider/Staff- Identification
  Window of the Provider on Insurance

5
Employer Preferences - How does it impact my
Insurance Claims?

• ID Treating Dentist By
• Allows you to select additional information that
  will identify the Treating Dentist and will print
  in Box 58 of the ADA 2006 form.
• Select from
• BCBS
• DEA Reg Number
• Delta Number
• Medicaid
• Medicare
• NPI
• Other Ids
• None
• All of the above information can be edited and
  saved in the Edit Provider/Staff- Identification
  Window of the Provider on Insurance

6
Employer Preferences - How does it impact my
Insurance Claims?

• ID Facility By
• Allows you to select additional information that
  will identify the Facility or Practice and will
  print in Box 52a of the ADA 2006 form.
• This area was designed to populate the
  information necessary for the CMS 1500 form,
  however, inputting information in this area will
  overwrite any information selected in the ID
  Dentist By section.
• Select from
• License Commercial Number
• Blue Cross Location Number
• Blue Shield Network Number
• Medicare Clinical Lab
• Medicaid Taxonomy
• UPIN State Industrial Accident Number
• Champus
• All of the above information can be edited and
  saved in the Edit Practice Information/Identificat
  ion Window

7
Employer Preferences - How does it impact my
Insurance Claims?

• Calculation Method
• Allows you to select how you want your Treatment
  Plans and Walkouts to calculate the Insurance
  Estimation for each patient tied to the specific
  Employer
• Select from
• Estimate Insurance estimate benefits based on
  the Employer Setup for Service Types, Fee
  Schedules and any Coverage Books assigned as well
  as considers patients remaining benefits and
  deductible.
• Insurance Company Responsible for All will
  place the entire charge in the estimated
  insurance (based on patient remaining benefits)
  and will always make the patient owed section
  zero regardless of Employer Setup for Service
  Types, Fee Schedules and Coverage Books
• Patient Responsible for All will place the
  entire charge in the patient portion regardless
  of Employer Setup for Service Types, Fee
  Schedules and Coverage Books (this will also
  input Pay Subscriber in field 37 so payment will
  go to patient rather than office.)

8
Employer Preferences - How does it impact my
Insurance Claims?

• Secondary Calculation Method
• Allows you to choose how you want your Treatment
  Plans and Walkouts to calculate the Secondary
  Insurance Estimation for each patient tied to the
  specific Employer
• Select from
• Amount Not Paid by Primary will calculate
  secondary benefits on the amount that is not paid
  by primary. This typically leaves a balance
  remaining for the patient to pay
• Example Service 100, covered at 80
• Primary covered 80, leaving 20
• Secondary the figures 80 of 20, which 16
• Remaining 4 is billed to Patient
• Submitted Amount will calculate secondary
  benefits on the amount that was actually
  submitted. This typically puts the entire
  remaining balance from primary in the estimated
  insurance, leaving the patient portion at zero
• Example Service 100,
  covered at 80
• Primary covered 80, leaving 20
• Secondary the figures 80 of 100, which
  80
• The total secondary insurance portion cannot
  be more than that total
  charge, so the covered about would be 20
• Remaining balance for
  Patient is 0

9
Employer Preferences - How does it impact my
Insurance Claims?

• Additional Options
• Authorize Payment to Office
• If you want the insurance check to be paid to the
  office, checkmark this option
• Will populate Signature on File in Box 37 of the
  ADA 2006 form.
• If Patient Responsible for All is selected under
  Calculation method, this will not be marked.
• Lifetime Maximum Applies
• If Patients tied to this Employer have a Lifetime
  Maximum of benefits, check this box.
• The benefits for patients with this marked will
  NOT reset
• Lifetime Deductible Applies
• If Patients tied to this Employer have a Lifetime
  Deductible, check this box.
• The deductible for patients with this marked will
  NOT reset

10
Employer Preferences - How does it impact my
Insurance Claims?

• Additional Options
• Do Not Track Claims
• If your practice does not file insurance claims
  for your patients, but still wish to provide a
  completed claim form to them, select this option
• This will print the insurance claim form, but
  will immediately close it so it does not stay in
  the outstanding claims area
• This will move any estimated insurance and move
  it to the patient portion
• Bill Standard Fee on Insurance Claim
• If your practice assigns fee schedules to either
  Employers or Patients, but wants the offices
  Standard Fee to appear on the Insurance Claim,
  select this box
• Show Tax on 2002 or Newer Ins Claim
• If your office wants to include tax information,
  select this box. This will place the tax
  information in Box 32 of the ADA 2006 form
• This option will only display if under File
  Preferences Employer, Show Tax on 2002 or Newer
  is checked