Automated VHI Insurance Process

The following steps outline the process for insurance claims marked as 'Approval Required':

When a treatment for a new claim is first planned in the dental chart it will appear in the treatments table like any other treatment. However, you will notice that the Complete Treatment icon is replaced with the Send for Approval icon, with the treatment status appearing as ‘Option’.

• From this screen, you will also be able to attach any notes or files that may be relevant to the claim. This can be done by selecting the plus icon  under the ‘Files’ or ‘Notes’ column for the respective treatment.
• Once you have finished attaching any relevant information click the send for approval icon to send the claim for approval.

• This will send the claim to VHI, with the treatment status updating to ‘Sent for Approval’ within the treatment table.

• At this point, the claim will either be approved, declined or queried.

‘Declined’ claims will follow the process outlined below:

• If the treatment is declined the user who is performing the treatment will be sent a notification via user tasks. User tasks can be accessed by selecting the ‘Task’ icon located beneath your name to the top right of Aerona. This icon will flash with the number of tasks outstanding. 

• Select the icon to view outstanding tasks. The task will be titled ‘Insurance Treatment Declined’, with the note detailing the reasons why, while also specifying the patient the task is linked to. Below task is linked to the patient ‘Patricia Pearson’.

• At this point, the status of the treatment will be changed to ‘Declined ‘within the treatment table.

• Declined treatments will remain in the treatment plan and can be resent for approval or deleted.

• Before resending, at this stage you can attach any notes or documents to the claim via the treatments table by clicking on  icon under the notes/file’s columns.
• To resend the claim you will have to click on the send for approval icon that appears when the treatment is selected in the treatment table

Once you have made the required changes to the claim the user can mark the user task as complete. This can be done by selecting the tick to the right of the task title.

N.B The user tasks can only be seen by users performing the treatment. This is not a form of communication with the insurance company and any notes written here will not be seen in the insurance portal. Notes need to be attached to the relevant treatment as highlighted in the above process.

The process for claims that have been ‘Queried’ is outlined below:

• Once the claim is queried the user who is performing the treatments will receive a new user task detailing the query. User tasks can be accessed by selecting the ‘Task’ icon located beneath your name to the top right. This icon will flash with the number of tasks outstanding.

• Select the icon to view outstanding tasks. The task will be titled ‘Insurance Treatment Approval Queried’, with a note detailing the reasons why, while also specifying the patient the task is linked to.

• The user can then make the required changes to the claim e.g. adding notes or files/documents via the treatment table within the treatment section.

• Once this has been completed the user will be required to resend the claim for approval. To resend the claim you will have to go to the treatment section and click on the send for approval icon.

• Once you have made the required changes to the claim, the user can mark the user task as complete. This can be done by selecting the tick to the right of the task title.

The following steps outline the process for insurance claims that do not require approval:

• If the treatment items do not require approval, the status of the claim will appear as planned when its added to the patient’s treatment plan.

• The user will then be required to complete the treatment by selecting this the tick option, which will send this information to VHI.

The steps below highlight the process for a claim that is ‘Declined’ at this stage:

• The user performing the treatment that has been declined will receive a new user task highlighting the reasons for declining the claim. The task title will be ‘Insurance Claim Declined’.

• The status of the claim will be changed Payment Declined. This can be viewed within the patient or claims section of Aerona.

• At this point the user can either change the status of the claim through the patient section or start the claim process over. Additional consult notes/files can be linked to the treatment if required.
• They can also edit the treatment and change the patient amount if they wish to proceed as a private treatment, adding a note to explain the reasons for charging the patient. Status can be updated to patient charged by going to Patient section > Financial > Insurance > Select to highlight claim you want to update > select the edit claim icon > the status should be changed to ‘Patient Charged’ and saved.

Once you have made the required changes to the claim the user can mark the user task as complete. This can be done by selecting the tick to the right of the task title.

The steps below highlight the process for a claim that is ‘queried’ at this stage:

• The user performing the treatment will receive a user task containing the queried claim details.

If additional information is required to progress the claim, then this can be added at this point by attaching any notes or documents to the claim via the treatments table by clicking on  icon under the notes/file’s columns.

Once the queried claim has been updated, the user should change the status of the claim in the patient insurance section by editing the claim. Go to Patient section > Financial > Insurance > Select to highlight claim you want to update > select the edit claim icon > the status should be changed to ‘Sent to Insurer’ and saved.

Once you have made the required changes to the claim the user can mark the user task as complete. This can be done by selecting the tick to the right of the task title.

• If the claim has been approved for payment the status of the claim will be changed to ‘Payment Pending’
• Once the payment has been made the status for the claim will change to ‘Paid’.
• There will also be a new payment in the claims section under Payments. The payment will already be allocated to the corresponding claim.