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Though there are many different ways to handle the insurance claims process, it can be generalized into a few common steps:
Patient Insurance details are summarized on the Patient Overview window. Before creating a preauthorization or insurance claim, be sure there is insurance attached to the patient record and clarify the benefit levels. However, the claim can be updated and rebilled if the plan is updated.
Preauthorization (Predetermination): Not all procedures require pre-authorization, but it is important to include it in the process. Though most billing and claims work will occur in the Ledger, preauthorizations require the Treatment Plan module.
Create Claim: Claims are created from the patient view of the Ledger. The Claims window offers opportunities to view and provide additional details from the insurance company.
Submission: Claims created in QSIDental Web may be submitted electronically or printed directly on paper using the form selected when the plan was created. Claims set for electronic submission are sent with the Batch Claims tool.
Follow-up: QSIDental Web has a number of reports that can be used to track and follow-up on outstanding claims. Additionally, 835 records, Explanation of Benefit Statements and funds may be managed in a variety of tools.
Payment: Insurance payments come from carriers in two ways: in single checks representing a single claim for a single patient or in a large batch check representing multiple claims for multiple patients. Users of QSIDental Web have the capacity to process both or to accept electronic payments using the 835 tools.