What is an insurance claim quarterly roll up?
For Pennsylvania Medicaid, when billing for periodic orthodontic treatment visits (D8670), you should bill for only one D8670 code per quarter. This applies to the last date the member was seen within that quarter, provided they were seen at least once during that period. The member must be seen at least once within the quarter for the provider to bill this code.
Why would I use this?
The D8670 code represents a full orthodontic treatment visit. Pennsylvania Medicaid's policy requires providers to bill for this code only once per quarter, reflecting the last visit within that period. This ensures that providers are appropriately reimbursed for the ongoing, regular orthodontic care required during the active treatment phase. Please note that you can use this feature for any use of the D8670 code.
Key Points:
- One D8670 per quarter: Only submit one D8670 code for the entire quarter.
- Last visit within the quarter: The D8670 code should represent the date of the last visit the member had with the provider during that quarter.
- Member must be seen: A member must have been seen at least once within the quarter to be billed for the D8670 code.
How do we turn this feature on?
Under Edit>Practice Information, Insurance Tab, select the option Enable Insurance Claim Rollup as shown in the screenshot below. *Note: If you do not see the Enable Insurance Claim Rollup as an option, please reach out to Support.
What effect does the Enable Insurance Claim Rollup option have on Insurance Claims on Existing Contracts?
This is not a retroactive feature. Going forward, new contracts can utilize this feature, as it shows fewer service lines on the insurance claims. Should you add this to an existing contract, the service lines will not change.
Examples of how this will look:
1. Quarterly Claim, No Rollup (Contract)
2. Quarterly Claim, No Rollup (Claim)- Notice that this claim has Three Service Lines.
3. Quarterly Claim- Rollup Selected (Contract)
4. Quarterly Claim- Rollup Selected (Claim): This has insurance roll up and has only one line on the insurance claim.
As always, if you have any further questions, please do not hesitate to reach out to Cloud 9 Support by emailing us at cloud9support@planetdds.com, or chatting us online using the chat bubble on the lower right at https://cloud9support.planetdds.com/hc/en-us, or giving us a call during our business hours of 8:00 AM EST to 8:00 PM EST at the 1.800.394.6050 option 2.