New Zealand Dental Benefits in Dental4Windows

New Zealand Dental Benefits in Dental4Windows

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Listed below are instructions on setup to use OHSA/SDSA and how to Generate NZ dental benefits SDS claim, SDSA claim, OHSA claim: high caried treatment planning, OHSA claim, OHSA claim: individual treatment and apply OHSA / SDS payments to claims. 

Preset & Setup Features

OHSA & SDSA Items

OHSA & SDSA items are preset in Dental4Windows Items page, there is nothing to do here.
  1. Go to Location Setup > Items tab
  2. Oral Health Services > Sub categories:
    OHSA Items in Dental4Windows end in O. Examples: FIL1O, DEN2O
  3. Special Dental Services > Sub categories:
    SDSA items in Dental4Windows end in S. Examples: FIL1S, DEN2S

Region List

The Region is preset however some editing is possible.
InfoHere are instructions

School List

The School List is preset however some editing is possible.
InfoHere are instructions

Setup Agreement Holder (Provider) details for claiming

The Payee Number, Agreement Number and Provider ID are required, in order to process Dental Benefit Claims.
InfoHere are more instructions

    Setup Patient File

    Patients under NZ Dental Benefits should be setup per the below instructions to ensure amounts owing and paid are responsible by OHSA/SDSA.
    InfoHere are further instructions

    Working with NZ Dental Benefits

    Charting Patients under New Zealand (NZ) Dental Benefits Scheme

    Charting procedures (linked to relevant item codes) can be found in 2D Charting or 3D Charting.
    InfoThe above items have been pre set to ensure the correct item codes are picked up for claiming.
    1. Go to Patient Record > 2D Charting or 3D Charting
      1. Oral Health Services menu> Select procedure

      2. Special Dental Services menu > Select procedure

    NZ Dental Benefit Approval

    Once a claim has been approved, the Approval Number must be added against the claim. 

    1. Go to Patient Records > Claims tab
    2. Enter the number in App No column for the relevant claim

    3. Once the Approval number is added to a Prior Approval claim, items in the claim will carry the Approval number when copied into Treatment
    Completing Treatment

    When the planned treatment has been completed, the items need to be transferred from Treatment Plan to Treatment.

    1. Go to Patient Records > Treatment tab
    2. Click the red bulldozer  icon
    3. Highlight the completed items and click OK
    4. The completed item will now appear in the Treatment tab, ready for claiming

    Generate a NZ Dental Benefits Prior Approval Form

    Items requiring prior approval can be entered using the Charting tab, or by entering the items directly into Treatment Plan.

    Only one request can be generated per Treatment Plan. A new Treatment Plan should be created if a prior approval request already exists for a plan.

    1. Go to Patient Records > Treatment Plan tab
    2. Enter items if not already entered
    3. Treatment Plan menu > Application for Prior Approval (NZ)
      1. If the patient does not have an NHI ID entered, enter it or select Create Claim without NHI Number
      2. Click OK

        1. Fill in the Application Form 
        2. Click Save                                                                                                                    
        3. Click Cancel to exit

        4. A copy of the application can be found in the Claims tab

    Generate New Zealand (NZ) Dental Benefits SDS Claim

    1. Go to Patient Records > Treatment tab
    2. Enter items if not already entered. Some items require the surface to be included to be approved. If a surface is entered against an item, it will be added to the comments field of the form.
    3. Itemised Invoices menu > New Invoice and Special Dental Services Claim
    4. Highlight the item/s in the background and fill in the form as required

    5. Click Preview then Print to print and save the form or Save

    Generate SDSA Claim

    1. Go to Patient Records > Treatment tab
    2. Enter items / Transfer from Treatment Plan 
    3. Itemised Invoices menu > New Invoice and Special Dental Services Claim

      1. Select items to include in the background
      2. Fill out the Application Form
      3. Click Save
      4. Click Cancel to exit

    Generate New Zealand (NZ) Dental Benefits OHSA Claim: High Caries Treatment Planning

    1. Go to Patient Records > Treatment tab
    2. Enter items if not already entered. Some items require the surface to be included to be approved. If a surface is entered against an item, it will be added to the comments field of the form.
    3. Itemised Invoices menu > New Invoice and Oral Health Services Claim
    4. Select High Caries Treatment Planning
    5. Highlight the item/s in the background and fill in the form as require

    6. Click Preview then Print to print and save the form or Save

    Generate New Zealand (NZ) Dental Benefits OHSA Claim

    1. Go to Patient Records > Treatment tab
    2. Enter items if not already entered. Some items require the surface to be included to be approved. If a surface is entered against an item, it will be added to the comments field of the form.
    3. Itemised Invoices menu > Select New Invoice and Oral Health Services Claim
    4. Select Individual Treat
    5. Highlight the item/s in the background and fill in the form as required

    6. Click Preview then Print to print and save the form or Save

    Generate OHSA Claim: High Caries Treatment Planning

    1. Go to Patient Records > Treatment tab
    2. Enter items / Transfer from Treatment Plan 
    3. Itemised Invoices menu > New Invoice and Oral Health Services Claim > High Caries Treatment Planning

      1. Select items to include in the background
      2. Fill out the Application Form
      3. Click Save
      4. Click Cancel to exit

    Generate OHSA Claim: Individual Treatment

    1. Go to Patient Records > Treatment tab
    2. Enter items / Transfer from Treatment Plan 
    3. Itemised Invoices menu > New Invoice and Oral Health Services Claim > Individual Treat

    4. Select items to include in the background
    5. Fill out the Application Form
    6. Click Save
    7. Click Cancel to exit

    SDSA and OHSA Claim Summary Forms

    SDSA and OHSA Claim Summary Form can be created for a period and printed. 

    1. Go to Insurances > OHSA/SDSA Claims tab
      1. Claims Type: Select from OHSA and SDSA
      2. Batch: Select New batch
      3. Batch Name: Enter a name for the batch, it will be saved as this name
      4. From / To Date: Select the period of claims to view
      5. Treating Provider: Select the Provider to view claims for
      6. Click Retrieve 

      7. Highlight: Select to highlight All rows shown above, or manually select those to include
      8. Click Create Batch
      9. Click Print  

        1. Tick Apply print/exit for all reports so all pages print together
        2. OHSA Report: The first printout will be the OHSA Claim Summary Form, followed by the OHSA Individual Treatment Report then High Caries Treatment Planning Treatment Report/Claim Summary Form
        3. SDSA Report: The first printout will be the SDSA Claim Summary Form, followed by the SDSA Individual Treatment Report
        4. Signature: Select a saved signature to be added to the form

    Apply OHSA / SDS Payments to Claims

    When a payment is received for outstanding OHSA and/or SDS claims, enter the payment as one amount for all associated patients. 

    1. Go to Patient Records > Receipts tab for any of the patients the amount relates to
    2. Receipts menu > New Receipt
      1. Payment From: Insurance, OHSA or SDS
      2. Amount: Enter the total amount of the payment (not just for this patient)
      3. Payment Type: Select how the payment was received 
      4. Autoallocate Payments: Remove the tick
      5. Paid: Enter the amount paid per patient (some will remain outstanding)
      6. Click Create

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