Set Up a New Patient for eClaims

Follow the steps below to ensure you will be able to e-file claims for a new patient in Tops Ortho.

1. Open the patient chart; go to View > Patient Info or press Command I.
2. In the Status/Notes/Alerts tab, select Student Status and choose one of the following:
   1. Full-time Student
   2. Non-Student
   3. Part-time Student
3. Place a checkmark in the Permits Release of Medical Information checkbox. You must have the patient or responsible party's signature acknowledging that claims will be sent electronically.
4. If the orthodontic treatment is the result of an accident, select Tx Cause and choose Accident Type, Accident Date (MMDDCCYY), and Accident Location (two-letter state abbreviation) where the accident occurred. This information will populate in boxes 45 and 46 of the claim form.
5. Click on the Insurance tab for the Employer Policy you wish to edit (Insurance 1, 2, 3 or 4). Navigate to the Assignment of Benefit field. For existing Policy Holders, this field should pre-fill. For new Policy Holders, select either:
   1. Billing Only (No Benefit Assigned) - select this if the insurance will pay the Policy Holder
   2. Pay-to (Benefit Assigned) - select this if the insurance will pay your office/doctor

6. Stay in the Insurance tab for the Employer Policy. Navigate to the Next Claim Date field. If a date does not auto-fill in that field, click the Calc button. Doing so will fill in the next claim date based on the information entered in the Employer Policy.

7. If the patient has more than one insurance policy, click the button labeled Policy is 1st for Coordination of Benefits. A window will display listing all insurance policies connected to the patient.
   1. Click and drag the policies to re-order them as primary, secondary, etc.
   2. Press Order by Birthday to sort policies by the Policy Holder birthdays.
   3. Click OK.
8. Open the Patient Relationship to PH dropdown menu and select the correct relationship between the patient and the Policy Holder.

9. See related articles Add a Policy Holder and Add an Employer Policy for the next steps.