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5.1 – Enabling Automatic EOB adjustments for Preauthorization

Description

You can now enable a setting which will automatically adjust the patient/insurance fee split on planned treatments. This feature will only affect planned treatments submitted for preauthorization. It will not take effect on Complete or Incomplete treatments. This gives your team even more incentive to utilize preauthorization; they need not be limited to big treatment plans alone, there is benefit to preauthorizing any upcoming treatments, no matter how small.

This article applies to version 5.1 +

Step-by-Step

  1. Visit the Transactions module.
  2. Select the Treatments tab.
  3. Select the wrench icon in the upper right.
  1. Select the Settings tab.
  2. Enable Update Splits for Planned EDI.
  3. Select Save.
  4. Close this window.
  1. Start a new claim.
  2. Set the Claim status to P for Planned.
  3. Enter your treatment code and details.
  4. Save.

Repeat steps 3-4 until all claim items are added.

  1. Select Submit.
  2. Be sure to choose the EDI option.
  3. Select Ok. You will be presented with the usual submission workflow. Confirm your choice in the pop-up windows that follow.
  4. Your treatments will be found at the bottom of this page, under the Planned/Incomplete tab.
  1. Once the electronic submission has processed successfully, a new pop-up window appears.
  1. Your claim response should also print (either to paper or PDF, depending on your office settings).
  1. The information attained via the preauthorization  is used by the program to automatically adjust your treatments splits.

You now have all the information required to proceed with your treatment plans confidently. Once the treatment has been delivered to the patient, you can convert the planned items into completed lines, preserving your patient/insurance splits in preparation for payment collection.

Additional Resources