Insurance Company Plans in Dental4Windows

Insurance Company Plans in Dental4Windows

Listed below is how to add a new insurance company, applying a co-payment to and invoice and an eClaim reconciliation with remittance. 

Add New Insurance Company

Feature Flash Video: Add a New Insurance Fund and Plan


Add New Insurance Company

  1. Go to Insurance > Insurances tab
  2. Operations menu > Select New Record
    1. Enter the details for the insurance company. (Not all fields must be entered. The minimum is the Name and Abbreviation.)
    2. Invoices to: Select how the insurance company would like to receive invoices, if applicable
    3. E-System: if using HCONNECT for claim, select HICAPS. This does not apply for other terminals.
    4. Card No prefix: If using HCONNECT, enter the insurance card prefix

 Next, an insurance plan must be added to show within Patient Details. 

Add New Insurance Plan

  1. With the insurance company in view, click the Add button (bottom right)
    1. Plan Code: This is the abbreviation for this plan
    2. Plan Name: This is the full name of this plan
    3. E-System: Select e-System 
    4. Tick Co-Payment is allowed is applicable (see below for more instructions)
    5. Amount: Enter rebate amount for each item if applicable

    6. Click OK

Applying Co-Payment to an Invoice

Co-Payment is used when the rebate amount for a Health Fund Insurance Plan is entered manually in D4W/PS. 
Info

The following are some entitles using the Co-Payment feature:

  1. South Australia Dental Scheme (SADS)
  2. Western Australian Government Dental Sub (WA GDSS)
  3. Victorian General Dental Scheme (VGDS)
  4. Victorian Emergency Dental Scheme (VEDS)
  5. eClaim Dubai Health Authority (DHA)

Setup Co-Payment 

  1. Go to Insurance > Insurances tab
  2. Insurance in view: Select Insurance  
  3. Highlight the Insurance Plan if already setup or Add New Insurance Company (see above for instructions)
  4. Click Edit
  5. Tick Co-Payment is allowed
  6. Amount: Enter rebate amount for each item

  7. Click OK

Applying Co-Payment 

  1. Go to Patient Records > Treatment tab
  2. Enter item/s 
  3. Itemised Invoices menu > Select New Invoice Only/ Press F2 key / Click New Invoice icon
  4. Tick Show extended attributes > Tick Auto allocation 

  5. Click OK to the following message 
  6. Click Create or Receive Payment to receive the gap

Receiving Payment 

When the Insurance/Scheme payment is received, it should be entered against the relevant patient(s).

eClaim Reconciliation with Remittance

Ability to reconcile multiple eClaims based on Payment Reference Number. The claims will have their outstanding balance paid off based on the reconciliation amount.
  1. Go to Insurance > eClaim tab
  2. Viewing:
    1. Select Pending Claims

      To create the claim for queuing  
      1. Click Create Claim

    2. Select Submitted Claims 
      1. Select With Remittance
      2. Tick Filter by Payment Reference 
      3. Select Payment Reference

  3. Location: Select the Location or <All>, if applicable
  4. Insurance: Select the Insurance or <All>, if applicable
  5. Click Reconcile by Payment Reference button


  6. Click Yes

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