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Manual Claims Process

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Manual Claims Process

Overview

Aerona’s claims section allows users to manually keep track of and update insurance claims with their respective providers.  This section allows the reconciliation of insurance fees associated with treatments and payments received from providers.

This is a manual process and is in no way automated with the insurance provider. Current processes in place at the practice will carry on as normal. The guidance below is to update records on Aerona.

 

Claims Section

Manual management of insurance claims can be done via the ‘Claims’ section of Aerona. See below located to left:

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This section is available to users with one of the below levels of Access:

 

  • Full Access
  • Practice Manager
  • Clinician - Multi-Site
  • Clinician  
  • Nurse

 

The Claims section will be separated into 4 subsections as below:

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2.1 All Items

 

This subsection will display records of all completed insurance treatments by month regardless of the claim status (Deleted items can be viewed by selecting the ‘Show Deleted’ checkbox). A month filter is available above the records table. This can be used by first selecting the desired month, followed by magnifying glass. See below

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This will return records for that month, detailing the following information:

 

  • Clinician 
  • Provider
  • Care Plan
  • Patient Name
  • Claim Reference
  • Treatment Date
  • Claim Date
  • Purchase Item (Treatment)
  • Tooth
  • Notes
  • Amount
  • Status

 

2.3 Mark as Sent

This section has been designed to manage and update ‘Pending Claims’ to status ‘Sent to Insurer’.

 

Claim items within can be easily filtered should users like a breakdown by provider, Care Plan, Clinician etc. Claims can be marked as sent by selecting the check box to the end of each claim and selecting ‘Save’. 

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Alternatively, multiple items can be selected at a time for convenience by selecting the checkbox alongside the column headings. See below: 

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NB: Care Plans can be set to ‘Automatically Send Claims’ upon an insurance treatment being completed. Having Care Plans set in this way avoids the need to manually complete this step. This can be updated by going to the Admin Section > Pricing > Care Plans > Select Care Plan > Select Edit Care Plan > Check ‘Automatically Send Claims’ > Save. 



2.3 Payments

This subsection will display all existing insurance payments added to Aerona, with the option to add new payments when processed by the respective provider. 

Adding a new payment is done by selecting the ‘Add Payment’ icon located above the payment table. When selected, the below dialogue will appear:

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Its recommended the reference includes Clinician Name, Provider, Month, Year. For example:

‘Dentist Peter, GMS, 09/2020’

Remaining sections to be updated to reflect payment details. When saved, the payment will appear within the payments table. 

 

2.4 Mark as Paid

This section allows you to mark claims as ‘Paid’ using the payments added within the payments section. This section will list all claims that have been updated to status ‘Sent to Insurer’. 

Within this section a drop down will be available to select a payment to allocate. This will display the payments by reference. See below:

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When a payment is selected from the dropdown, the option to allocate to claims will be available. An additional column will appear to the far right of the claims table. See below: 

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We can filter the claims to table to display by clinician and provider. For example, I would like to allocate to GMS claims for Dentist Peter completed in September 2020. I first select the respective payment from the dropdown and filter the claims as below:

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This will populate all claims for Dentist Peter for September 2020 for GMS. I can allocate the payment by selecting the check box for each claim covered with the payment added. See below: 

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You can select multiple claims by selecting the checkbox running parallel to the column headings. You will see the allocated amount updating above the table as you can see from the image above. 

Selecting save will complete the allocation and mark each claim as ‘Paid’. Once saved, the claims will no longer be viewable in this section. 

 

Viewing Claims Allocated to Payment

 

Users can view claims allocated to payments via the payment subsection. From within this section a list of payments will be viewable. To view the claims allocated to a payment, select the payment from the table. Once selected an option to view via the ‘Print Associated Items’ icon located above the payments table. See below: 

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When selected, a list of associated items will be viewable. These can be printed or exported to Excel/CSV for further management. 

 

Managing Individual Claims

 

The claims section also provides the flexibility in managing claims on an individual basis. Depending on the status of the claim, this can be done via in two areas. 

 

4.1 Managing individual claims with status ‘Pending’

 

Claims pending can be updated via the ‘All Items’ subsection. You can manage a claim of this type by selecting it to highlight, with options to manage appearing above the claims table. See below: 

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The ‘Edit Claim’ item icon mceclip12.pngwill populate a dialogue that will provide several options to update the claim. See below: 

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From here the amount to be claimed can be modified, while also having the option to update the claims status to one of the below: 

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NB: The ‘Patient Charged’ option will convert the insurance amount to a private amount.

An option to add a note is also available to allow users to add further information to detail the reasons for modifying the claim. Selecting ‘Save’ will apply the changes made. 

 

The Bin icon mceclip15.png will allow you to delete the claim.

 

4.2 Managing individual claims with status ‘Sent to Insurer’

 

Claims with status ‘Sent to Insurer’ can be modified within the ‘Mark as Paid’ subsection. In order to have the ability to edit a claim, a payment must be selected from the drop down. When a payment is selected, a pencil icon will appear beside each item within the ‘Received’ column. See below:


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When selected, a dialogue will appear to provide the option to modify the claim. See below:

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This dialogue will provide the option to update the claim as required. Selecting the save icon mceclip18.png  will update the claim. To finalise the changes, the check box in the end column needs to be selected. Selecting ‘Save’ to the top right will finalise the changes. See below:

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Claims under the status 'Sent to Insurer' can also be reverted via the Patient section > Financial > Insurance > Select the 'Edit Claim item' pencil below > Update Status dropdown > Save.  Please see example below:

 

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Reports

 

Reports section includes a set of reports designed for insurance items. These can be viewed by going to Reports > Insurance. See below for a list of reports designed for claims managed through the ‘Claims’ section:

  • Planned Insurance Treatments Report
  • View Planned Insurance Treatments by Date Approved Report
  • Completed Treatments Marked as Sent by Date Claimed Report
  • Completed Treatments Without Clais
  • Claims Item Report
    • Date range will only filter those items that have been claimed (Sent to insurer or paid)
    • Any claims pending have the status ‘unclaimed’. Leave date range blank and filter status to unclaimed.
  • Claims Items Report Without Declined
  • Claims Monthly Summary Report
  • Planned VHI Insurance Treatments Report
  • Completed VHI Treatments Marked as sent by Date Claimed Report







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