Summary: When a claim is placed on hold, it will prevent the claim from being generated. This can be useful for a number of reasons in an office, like needing extra time to gather information or prepare claim attachments. You can use this tool to review and take extra time for special cases. The hold will remain active until it is unselected. If the claim remains unselected for a long period of time, it can cause issues with billing. Be sure to check on your held procedures/claims and the steps need to remove their holds frequently.
Use case description:
When your office generates a Claims Not Created report, you may find that a procedure was previously placed on hold and as a result, has not been attached to a claim. When your team looked at the ledger, they may have found the letter H in the Bill column. When this happens, the procedure is being 'held' from claims and will not allow a claim to be generated for it.
Signs:
- A red H under the Bill column
- The procedure appears in Claims Not Created report
- The Est Ins shows an owed balance but no claim is related to the balance
Basic Hold Claims steps:
Holding:
- Select the desired patient.
- Locate the procedure to place on Hold.
- Click the Date of Service (DoS) and select Hold Claim.
- Save to finalize.
Un-holding:
- Select the desired patient.
- Locate the procedure that was held.
- Click the Date of Service (DoS) and deselect Hold Claim.
- Save to finalize.
Best Practices:
To avoid an issue in the future, be sure that your office is regularly checking the Claims Not Created report (Reports > Insurance Reports > Claims Not Created) for instances of stuck procedures daily or pulling a report for each day of service at the end of the week. This will show your team where there is work needed to be done.
Additionally, you can ask team members checking out patients use the Unbilled Procedures* filter in the ledger to check for patients procedures not billed and mark them for review and/or payment.
Advanced Hold Claims steps:
Holding claims:
- Search for the patient in the top right by their last name or patient ID. Alternatively, check the Scheduler for the patient you wish to review, right click their appointment and select Go To > Ledger...
- In the top right hand corner, select the drop down reading Show All and instead select *Unbilled Procedures. This will limit the amount you need to scroll down. This works even if the patient portion is paid.
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Click the DoS on the far left for the procedure that you wish to place on hold.
- Access to this option is also available from Transaction Entry by either clicking a DoS or when adding a new procedure.
- Find the option for 'Hold Claim' and select it by clicking the check box. A check should appear in the box.
- You may now select also choose to include a note about why the procedure was held to help your practice in the future.
- Press Save to finish the process and hold the claim.
- Repeat for any other desired items.
'Un-Holding'/releasing claims:
- Search for the patient in the top right by their last name or patient ID. Alternatively, check the Scheduler for the patient you wish to review, right click their appointment and select Go To > Ledger...
- In the top right hand corner, select the drop down reading Show All and instead select *Unbilled Procedures. This will limit the amount you need to scroll down. This works even if the patient portion is paid.
- Click the DoS on the far left for the procedure that has the H under the Bill column.
- Find the option for 'Hold Claim' and unselect it by clicking the check box. The check should disappear.
- Press Save to finish the process and release or 'Un-Hold' the claim.
- You may now select Patient Ledger from the options on the left side above the procedure grid.
- Select the newly released procedure and press Create Claim to begin the claim generation process as normal.
- Repeat for any other impacted items.
Contact support:
If you are not able to resolve an issue with a hold after following these steps, please take a screenshot of from the top left of the screen (program name and icon) to the bottom right (date and time). We encourage you to take a screenshot of both the Ledger showing the held procedure and the Edit Treatment screen displayed by clicking a DoS.
Click Help > Get Help to either click on your account name > My Activities to reply to your existing ticket about this issue or file at ticket a new ticket for this question.
'Add to conversion' allows you to enter a photo if you are in an existing ticket and new tickets have a specific selection for images to send via a HIPAA compliant communication system to our support team.
Additional resources:
- Is it necessary to batch claims in the “Batch Claims Processing” screen?
- I’ve saved my claims to the batch claims area. How do I electronically submit the claims to the carrier?
- When we send our claims to DentalXChange for processing, we see various status messages on claims. What are the status messages used on the DentalXChange website?
Conclusion:
This guide has shown you the tools needed to hold and un-hold claims. While the option to use these claims does lie in your hands, be sure to include notes on procedures with dates and initials for awareness to the rest of your team or your future self. Clear communication in any office is key and this tool can only take your team as far as you are able to communicate its use.