File a Manual Claim

Sometimes a patient's contract doesn't allow you to generate a claim. When this happens, you can print a claim form and fill out the information manually. Here's how!

Review the Contract

1. Our example patient, Greg, did not have insurance coverage until the middle of his treatment. The practice will file claims on his behalf.
2. First, open the patient chart by going to Action > View Patient Info... or pressing Command I.
3. Click on the Contracts/Ledgers tab.
4. Double-click on the active contract to open the Contract Worksheet.
5. 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?
6. Since Greg paid in full at the beginning of his treatment, his contract does not meet the above criteria.

Enter the Insurance Information in Tops Ortho

For more detailed information on this step, see related articles below.

1. Open the patient's Insurance 1 tab.
2. Click Choose Policy Holder.
3. Enter the Policy Holder information.
4. Enter the Employer Policy information.
5. Select the Assignment of Benefit:
   1. If the patient will receive the insurance payments, select Billing Only [No Benefit Assigned]
   2. If the practice will receive the insurance payments, select Pay-To [Benefit Assigned]

Print the Claim

1. Go to Action > New Insurance Claim...
2. For the Claim Type, select Date Range.
3. Select your desired claim Form.
4. For the date range, enter today's date for both the beginning and end date. It doesn't matter what you enter here, as the claim will not pull contract charges.
5. In the Remarks field, enter pertinent information for the insurance company, such as the banding date, total treatment fee, etc.
6. Click Add New Claims to Tops...
7. The claim will open but will not save to the patient chart due to the lack of contract charges.
8. Go to File > Print and write in desired charges.
9. Scan and save the manual claim before submitting; place it in the iPortfolio.