Medical Insurance
Billing medical insurance may be useful for oral surgery and in hospital settings.
Turn on Medial Insurance Features
In the Main Menu, go to Advanced Setup and click Show Features, then select Medical Insurance. You will need to restart Practice-Web for your change to take effect.
Set Up Medical Insurance Plans
Patients can have unlimited Insurance Plans as managed in the Family Module. To designate an Insurance Plan as a medical plan versus a dental plan, complete the following steps:
- Check the Medical box. On the Edit Insurance Plan window, check the Medical Insurance box to identify the plan as medical instead of dental.
- Select the claim form. (Note: If printing, you will need to use pre-printed forms.)
- HCFA 1500 Claim Form: 1500_02_2012 is the new 1500 Health Insurance Claim Form (version 02/12) that is included in version 14.2. 1500 is the old version of the form. To reassign the new 1500_02_2012 claim form to current insurance plans, see Claim Forms, Reassigning Claim Forms.
- UB04: The UB04 form is not used in e-claims and is usually used for institutional claims.
Use Medical Codes
In the Procedure Edit window, Medical tab, there is a box for medical codes. If a default medical code is entered for the Procedure Code it will be filled in automatically.
When a new claim is created for a medical insurance plan, each Claim Procedure code sent to insurance is copied from the medical code of the corresponding procedure if the medical code is not blank.
Diagnostic Codes (ICD-10)
International Classification of Diseases, Tenth Revision, Clinical Modification Codes (ICD-10) are required for HIPAA-covered transactions as of October 2015. See CMS.gov ICD-10. See the section on downloading medical codes if you don't have the ICD-10 codes.
In the Procedure Edit window, Medical tab, you can enter multiple ICD-10 codes for a procedure. For each visit, one procedure needs to have the Principal Diagnosis box checked.
Download Medical Codes
The Code System Importer is used to download and update ICD code systems. To access this setting, from the main menu, choose Setup > Chart > Code System Importer. Then, select the code system you want to download and click Download Updates.
Procedure Codes
Medical codes can be entered in the Procedure Code List just like any dental code. For cross coding, you'll then simply go to the Edit Procedure Code window, accessed via Lists > Procedure Codes, select the correct dental code, and add the medical code in the appropriate field.
Assign Codes
Medical codes can also be assigned to Problems and Procedures.
Problems: To attach a medical code to a Problem, you'll use the Problem Def Edit window. Go to Lists in the main menu, then select Problems, and choose the appropriate Problem from the list. Click the picklist ellipses button [...] next to ICD-10 Code to select the code you'd like to associate with the Problem.
Procedures: To attach a medical code to a Procedure, open the Procedure Edit window and go to the Medical tab. Codes can be entered manually next to each Diagnosis Code field or you may choose from the picklist.
When choosing from the picklist, the ICD10 window will open and the list will be blank. Enter a few characters in the search box and click Search or leave the search box blank and click Search to have all options appear in the list.
Create and Send Medical Claims
If a patient has medical insurance, and there are completed procedures with a medical code, clicking New Claim in the Account Module will automatically create a dental claim and medical claim. The dental claim will show the dental code, and the medical claim will show the medical code.
Insurance Plan
On the Edit Insurance Plan window, check the Medical Insurance box. This is used for medical and institutional claims, and controls whether claims go out in dental format or in medical/institutional format. Also set the Claim Form to UB04 or 1500, in case you print paper claims.
Printing Claims
The medical insurance plan will use the 1500 Claim Form (see Insurance Plans above). You must print the 1500 claim form on preprinted forms because the red background has special requirements and they do not allow printing the background from a printer.
Clearinghouse
In the Clearinghouses list, set a default for dental and a separate default for medical/institutional. Dental clearinghouses cannot accept medical or institutional claims. If you will generate claim files from Practice-Web and upload them manually to Medicaid, you still need to set up a clearinghouse to specify the Claim Export Path. The Format for dental claims can be 4010 or 5010, and you can freely switch between them as needed. Medical and institutional claim format will be only 5010.
E-Claims
If Medical Insurance is involved, E-claims are created differently. You will use Change Healthcare (formerly Emdeon Medical) to process your claims.
Send Claims
In the Send Claims window, send batches of claims to one clearinghouse at once.
[Technical note: To determine the format, information is required from both the claim.MedType and the clearinghouse.Eformat. Neither alone is sufficient.]
Once messages are generated, they are archived in the etrans table in the database for later retrieval. These archived claims may be seen in the history list at the bottom of the Send Claims window. All 4 claim types (med5010, inst5010, dent5010, dent4010) will show as "claim sent" in the archival.
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