Insurance Assignment of Benefits

[Joe Gordon]

We have a problem with the Asignement of Benefits (AOB) checkbox. When it is checked, all of the claims sent for the family show the sig on file for every claim ever submitted for that insurance. Even if AOB was not checked when the claim was submitted years ago, or whenever. We should be able to look up any claim and determine if we received payment when the claim's AOB was blank, then it is the ins co's fault. Likewise, if the admins properly checked the box, and the patient received the ins check, I know it was the fault of the ins co, and not our front desk.
Another related problem is our insurance aging report. We run a query to view the claims sent- with AOB checked- that we haven't received payment for. But if we just chnged to accepting assignment for a particular patient for the latest claim only, all of their claims (even the ones we weren't supposed to receive reimb for) now show payment not received and populate on the list. And for the people who don't ever like to pay people they owe, we now uncheck AOB, and all the claims we are waiting on won't populate on the list.
Is this a bug or a glitch in the system?

[jordansparks]

Well, that's a plan-level field rather than a claim-level field. It would be just like if you changed someone's name. It won't show their old name when you pull up an old claim because patient name is not a claim-level field. The fields that seem like they are not going to change, we don't bother tracking at the claim level. That's a field that we hoped people wouldn't change too much. It was sort of designed to be a one-time set and forget kind of field. I'm curious why you would be making such frequent changes. Open Dental would have to be enhanced to support frequent changes, so it's probably not a good idea.

[Joe Gordon]

We switched years ago to requesting payment at the time of care, because most people wouldn't pay their bills. Tracking them down was a nightmare, and then they all read from that same script. So no more of those problems. For great parents with multiple children- we started to accept assignment. Then with many losing jobs, we accept assignment and payment plan. So that box is checked more and more these days.
One of the things I have been thrilled about is the XCharge enhancements so we can store the tokens and keep the credit card on file with no human error. Yet we still get the people who play the game-rotate their cards every other month to avoid paying anybody. Then of course we uncheck the box.
Pretty wild-many families that we requested payment at care were always wonderful, no problems. Now when we accept the insurance, they spend hours on the phone or at the desk trying to get out of what they owe. Then we realize we should have never switched. Uncheck the box--> back to wonderful relationship.
Then we have the families who say they can't pay by CC and we put them on payment plan for check in the mail, and we don't receive it, then call weeks later, argument, leave the practice.
One of the greatest things about OD is the ability to automate so many things, again less human error. I am hoping to have a system now for recurring charges for balances- I think that is a new enhancement, right? How about automation for when an ins payment is receied, the CC is charged for the entire balance (or recurring charge at first of month), and atatement emailed to guarantor? Would love that.
So back to the first post- When we check the box now, all those other claims from years back show as unreceived and it doesn't make sense. I feel that should be a claim-level field. As much as I would hope that our admins are completrly on top of this, thay still lose track of claims, because we have to resubmit because a mom gave us dad's wrong birthdate. Plus,I like our staff to spend time on patient care rather than acting as customer service for financial institution- that can waste hours a day.

[Joe Gordon]

Jordan, since an insurance claim is an official document, isn't this something that, once generated, should not be altered? If a name, or group #, or anything on the document changes, we should be required to generate an entirely new one to correct the changes. So there should be an official record that can be checked or verified, including assignment of benefits. We have had some issues with claimconnect that hopefully have been worked out. Over the past couple months, several insurance companies have requested that we resend claims because of processing errors. Some the insurance companies' error, some clearinghouse errors, some our errors.
Are you palanning on correcting this soon?

[jordansparks]

We do it the same way as all other dental software. Our approach is actually better than most. When I used to use Dentrix, if the patient changed insurances, we could never print an old claim without changing them temporarily back to the original insurance. We do save copies of the e-claims. Those copies and the accompanying reports account for most of the database size bloat.

[Joe Gordon]

Not so for Dentrix. Once a claim is generated, there is a permanent official copy of the claim that cannot be altered. Only way is to delete the old claim, and generate a brand new one.
I certainly appreciate the efficiency of OD. If our admins receive the wrong ins card from a patient and then have to reprocess the claim under the correct ins, they don't need to delete/ enter/ reprocess. But in the case of insurance claims, there should be an official record, and we should be able to run searches based on the permanent form. Another big problem we have run into is what you mentioned. If a patient or our office was never reimbursed for a claim from months ago under a different insurance, In order for us to resubmit the old claim, we need to delete all of their current ins info, enter in all the old ins info, resubmit, then reenter all their current info. Because we don't have that info from many months ago, we have had to search our old dentrix data to find the old claims and ins data. I could be wrong on this, but I believe the other big pm software are configured like dentrix with regards to these ins claims.
I feel this is a problem, and should be corrected.
btw- no matter what, and for anyone considering switching or starting fresh with pm software, OD is still the best by a longshot.

[jordansparks]

Thanks for that last bit.

You are familiar with our claimform setup window, right? It's ancient. It's kind of like our first attempt at sheets. Well, claimform setup will eventually be converted to sheets. Once that's done, we could start archiving claims with the flip of a switch. Now that wouldn't support running searches, but it would be an archive.