Creating claims from a contract is a convenient method of auto-generating insurance claim information based on the already entered contract information, as long as certain conditions are met. When you set up a contract for insurance, you will need to ensure that the transaction types are correctly set up. For more information on how to do this, see Creating Contracts in Cloud 9.
Setup:
Go to Edit > Setup > Transaction Types, and check the desired contract type. Hit the "Edit" button to make changes.
Make sure the Transaction Type is marked as "Is Contract". The Default number of payments in optional, but can be a time saving option.
Any Transaction Codes for the contract are entered in the following section:
This will ensure that the contract populates with the correct CDT code for filing the claim. This is the orthodontic method of entering the transactions codes. It is important that you do not enter the code into the box under "Transaction Type", as this is only used for Fee Schedules and Financial Arrangements (see Setting up Fee Schedules).
The Contract:
As long as the patient already has insurance added before the contract is created, the insurance plan will generate automatically. You will set this contract up with your normal workflow (Creating Contracts in Cloud 9). When you set up the insurance plan portion, you will need a minimum of 1 in the "# of Claims" box. If you only need one initial claim for the entire treatment then you are done.
To navigate directly to the initial claim for this patient, you can click the "Initial Claim" button.
This will take you to the claim page where you can edit the claim itself, inside the Insurance Claim Queue.
The claim will look like a typical ADA claim. However you will not be able to click on this button until after you have started the contract.
NOTE: Once you start the contract you will not be able to make further changes without adjustments from the ledger! Do not start the contract until you have finalized all details!
If you need to file continuation claims for the contract, you can simply check the "Continuation" button, then edit the number of claims to the appropriate amount. This will automatically generate continuation claims for an evenly split amount of the total Future Due.
You can adjust these amounts manually if needed but the total of the Ledger Amount column must be equal to the Future Due or you will get a red Error along the bottom of the screen.
You can change the frequency of the claim dates by changing the Frequency dropdown to match when the insurance requires you file continuation claims.
When you have all of your settings correct, you can save and start the contract.
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.