Insurance Reporting

Tops provides several reports to help you understand patient insurance coverage and to help maintain accurate data.  

The D7 Patient Care Tracking report allows you to view current patients by status. The report also reflects if the patient carries insurance, based on what may be represented in Insurance 1 and Insurance 2. Columns are available for sorting. Navigate to Matrix and then D7 Patient Care Tracking. More information is detailed below.

The Insurance Set-up Validation report allows you to view employer policies attached to patients. Navigate to Reports and then Insurance Set-up Validation. Use the Insurance Set-up Validation Report to review and correct any missing or incorrect data that could impact claims. More information is detailed below.

The Policy Holders matrix provides a list of all patients attached to policy holders, including the patient's remaining benefit on the specific policy. Navigate to Matrix and then Policy Holders. More information is detailed below.

The Accounts Receivable report displays a list of all patients with either a positive or negative balance due. This report not only displays copay balances and copay balance aging, it also shows the patient's Expected Insurance balance along with the last insurance payment amount, last insurance payment date and the last kept appointment.   Navigate to Report and then Accounts Receivable.  Please visit the related articles for more information.

The Claims Matrix is a centralized view of all open insurance claims in Tops. The claims matrix can be sorted by Employer Policy or by Insurance company.  Navigate to Matrix and then Claims. Please visit the related articles for more information.

D7 Patient Care Tracking Matrix

The D7 Patient Care Tracking is an excellent report to view your current patients by status and what insurance they have provided the practice.  This report allows visibility into the current insurance carriers that your current patients are utilizing for possible orthodontic benefits.

Use the D7 Patient Care Tracking report to view current patients by status and their insurance coverage.

Steps:

1. Go to Matrix>D7 Patient Care Tracking
2. Select a patient status (e.g., Active Treatment)
3. Apply filters at the top of the window
4. Review Insurance 1 and Insurance 2 columns
5. Click column headers to sort by payer
6. Highlight payers to view totals
7. Export the report for further analysis

Insurance Set-up Validation Report

Steps:

1. Go to Reports>Insurance Set-up Validation
2. Review patients with employer policies and policy holders
3. Look for:
   • Missing or incomplete data
   • Incorrect setup that could be impacting claims

Tips:

• The report is hot clickable for quick corrections
• Sort data to review insurance across all current and dismissed patients, regardless of status.
• Regular use helps keep claim forms accurate and complete

Policy Holders Matrix

Steps:

1. Go to Matrix>Policy Holders
2. Ensure Include Policy Holders With No Patients is unchecked
3. Review:
   • Remaining Benefit
   • Next Claim Date

Key Reminders:

• If no remaining benefit exists but claims are still open and generating
  • Verify
    • If there is no benefit remaining, close the claims and uncheck Make Claims Automatically
    • If there should be a remaining benefit, update the remaining benefit in the patient’s chart and the next claim date.
  • Confirm the policy is still active and configured correctly
  • Review the patient’s contract. Is it deactivated? Are the scheduled contract monthly dates correct?

This report is hot clickable, allowing quick access to update patient records.