Generate a Work in Progress Claim

Sometimes patients gain insurance coverage mid-treatment - here's what to do when they ask you to file a claim!

Review the Contract

1. Open the patient chart; go to View > Patient Info... or press Command I.
2. Click on the Contracts/Ledgers tab.
3. Double-click on the active contract to open the Contract Worksheet.
4. Review the contract and determine the following:
   1. Do the charges span the total treatment time?
   2. Does the initial fee cover 20-30% of the contract total?
5. If the above is not true, you will likely need to create a manual claim. If the contract meets the above criteria, continue to the next section.

Generate the Claim

1. Note the charges that have already been posted to the patient ledger. In our example below, 15 months have charged out so far.
2. With the patient chart still open, go to Action > New Insurance Claim.
3. In the Claim Type field, select Date Range.
4. In the Form field, select your desired claim template.
5. In the Dates fields, enter a date range that covers the charges already posted for the patient. In our example, we would enter 6/21/2023 through 10/1/2024. This covers the date of contract activation through the last posted contract charge.
6. In the Notes field, enter any internal office information you wish to include.
7. In the Additional Comments field, enter the Remarks you wish to appear on the claim in box 35. The insurance company may guide you in what to add here. As of Tops v9.11.0, the Remarks field has an 80 character limit which leaves 21 characters available after the 59-characters used for detailing the initial fee and monthlies in an initial claim, if applicable. For more information on this, please see related article Character Limits for eClaims.
8. Click Add New Claims to Tops.
9. The claim will generate for you to e-file or mail!