Generate a Pre-Estimate Claim
Your patient wants you to send a pre-estimate to their insurance. How can you do this when they have not yet begun treatment? We've got you!
- Open the patient chart.
- Make sure that the patient's treatment plan has been set up in the Dx/Tx Plan section in their Clinical chart. For claims purposes, you must fill in Dental Classification, Treatment Phase, and Treatment Length. A Treatment Plan name is not required but is helpful:
- Next, go to the Admin side of the patient chart and click on the Contracts/Ledgers tab.
- Double-click on No Contracts under the treatment plan you created (this is why the Treatment Plan name is handy, in case you prepared more than one treatment option.)
- The contract worksheet will open. Enter the contract information, including the expected insurance amount, just as you would if the patient were starting treatment.
- Record the contract only; do not charge the Initial Fee.
- Go to Action > New Insurance Claim and select the Pre-Estimate Claim claim type from the dropdown.
- Select the contract that you just recorded and click Use Selected Contract.
- Select a claim form (typically ADA 2019 Claim) and enter Remarks, if needed (the second field).
- Click Add New Claims to Tops.
- Tops will generate the Pre-Estimate Claim for e-filing or mailing.
Note: If you receive a Clearinghouse Rejected error upon submitting the pre-estimate noting that a start date and months of treatment are required, you will need to enter the required information to resolve the rejection. There are some payers (i.e. Principal) that require you have a start date and months of treatment entered. The start date essentially becomes the "request date" and cannot be a date in the future.
