Summary
Contracts assist patients in financing their orthodontic expenses. These contracts also control autopayments; autopayments can only be established within an active contract, as long as your practice uses an integrated payment processor with Cloud 9. While all contracts share core components, the setup may vary, with some contracts involving only a Responsible Party (RP), others including insurance, and some a combination of both. This article provides guidance on establishing a "Contract" transaction type and the prerequisites necessary for contract creation. There is also a high-level overview of the Contract's sections, fields, and drop-down menus. At the bottom of the page there are Quick Link Guides to various contract types and step-by-step instructions on how to set them up.
Contract Transaction Type Setup
NOTE: Skip this section if your contract transaction types are already set up.
You need the correct transaction type to start a contract. Ensure you have "Edit Library Items" permission from the practice. Then, go to Edit > Setup > Transaction Types in Cloud 9. Familiarity with transaction type setups is useful; this article can assist: Transaction Type Setup. For a contract transaction type, select "Is Contract." This automatically selects "Affects Production," which is intentional. Also, ensure "Show on Practice Summary" is selected. To confirm consistency, compare with another contract transaction type. Below is a sample screenshot.
Pre-requisites to Creating Contracts
Before creating contracts, a financially responsible individual must be set up in the Edit > Relationships tab for the patient in Cloud 9. If a patient has insurance the insurance plan must also be set up in the Edit > Patient > Insurance tab.
Pre-requisite 1: Verify Financially Responsible Party.
1. From the Home Menu, click Edit Patient.
2. From the Edit > Patient window, click the Relationship tab.
3. Verify that 'True' displays under the responsible party column for individuals responsible for payment.
Pre-Requisite 2: Verify Insurance.
1. From the Home menu, click Edit Patient.
2. From the Edit > Patient window, click the Insurance Tab.
3. Verify Insurance has been entered.
Understanding the Upper Portion of the Contract: Drop Down Menus
To access and add a new contract for a patient, from the patient ledger, click the handshake icon.
Next, click the blue "+Add" button to open the contract screen.
From this page, there are several fields we will review and define. First we will work in the upper section of the contract, above the blue line. The first three fields on the left hand side should automatically pull.
As shown in the above screenshot, the plan status will always read "New" when creating a contract. The Provider and Assigned Location are pulled from the Edit > Patient screen, but double-check these values. The Posting Location defaults to your Cloud 9 location you are currently logged into, but can be changed. Once verified, proceed to the next column on the right.
In the second column, click the magnifying glass on "Charge Type" and select the appropriate contract transaction type, such as Aligner Phase I. The "Plan Description" auto-fills from the transaction setup. To apply a discount, click the magnifying glass on "Discount," select the applicable discount, and enter the amount; leave blank if none. This leaves the "Plan" field as the last one to configure (screenshot below).
For the "Plan" field, click the drop-down arrow. Select an RP or insurance with a blue check mark to allow that to be viewable in the contract, then click elsewhere in the contract to allow the field to update. In the example, I selected Cigna Dental and clicked elsewhere; now both the insurance and RP appear on the contract. (Screenshot below.) Move to the third column next.
The third column's "Expected Start Date" should indicate the anticipated start date if not starting immediately—it does not initiate the contract. "Expected First Charge" should list the projected date of the first charge if not billed today. Both are optional and can be left blank if starting the same day. The "Treatment Fee Amount" reflects the total contract amount. "Discount Total" shows any applied discounts, and "Contract Subtotal" is the amount after subtracting discounts from the treatment fee. Move to the last column in this section of the contract.
The last column of the upper contract includes "Origin of Start" and "Payment Arrangement," mainly for clients with Gaidge add-on integrations for custom reporting. You can set up a transaction for "Origin of Start" and a data miner to pull that info, but if you don’t have Gaidge, you will likely want to leave these fields blank. The Initial CDT code defaults to the diagnostic code in Edit > Setup > Transaction Types (see "Contract Transaction Type Setup" in the first part of this article). The final field, "Payment Plan Totals," must match "Contract Sub Totals" and draws from data entered in the lower section of the contract, which we'll review next.
This is how the contract fields look at this point before we move to the lower section.
Understanding the Lower Portion of the Contract: RP and/or Insurance Plans
Once the contract fields in the upper portion of the contract are filled out it is time to move to the Lower Portion of the contract, which is everything below the blue line. Since this Patient has a Responsible Party, (RP), and insurance, both sections need to be filled out with the applicable information. Let's review these fields. Firstly, ensure the amounts entered in the "Plan Amount" for each entity equal the "Contract Sub Total" from the upper section. For the example, I will make sure that I have a total of $3,325.00 in the fields shown in the screenshot below.
On the RP tab the "Plan Amount" of $1,525.00 is entered. On the Insurance tab the "Plan Amount" of $1,800 is entered. The sum of the "Plan Amounts" is located in the "Payment Plan Totals" from the upper portion of the Contract. It is vital to check the amount is correct and matches the "Contract Sub-Total Field." For the example it equals $3,325.00, the entire amount of the created contract.
The next step is to move to the RP tab of the contract and locate the "down payment" field. It may not be applicable but if there is a down payment on the RP side, this is where it should be entered. The example has a $500.00 down payment entered. The next step is to enter the "# of payments" and select the "Frequency" fields for the "Plan Amount." Once this has been done, the tab will look like the below screen shot.
*Note: "Charge Dates", "Auto Pay" dates, and "Auto Pay" amounts cannot be edited until the contract is started.
The next step is to shift to the right to the Insurance tab. In this tab, the plan amount has already been entered but more details are needed.
As visible above, the "Continuation Diagnostic Code" is already attached, as that is attached to the transaction type. Since an E-claim will be submitted for this Insurance, we also want to make sure the "Initial" and "Continuation" claim boxes are checked. (For E-claims, clients must have an integration with Dental Xchange to submit claims electronically.) A down payment should be entered if one is expected, as well as the "Initial Claim" amount. Additionally, "# of Claims" needs to be entered and the "Frequency" of claims should be selected from the drop down to finish this section. At this point, the below screenshot illustrates how the Insurance tab of the contract looks with fields filled out prior to the contract start.
*Note: Initial Claim amount should be the entire amount of the contract.
In the Example contract, now that all fields are entered in the RP and Insurance tabs, the contract can be saved. It will save in a new status until the "+Start" button is selected to start the contract. Please make sure to double check your work as once you "Start" the contract you can no longer edit most fields above the blue line.
Once you hit the "+Start" button, the contract will start and you can fill in dates for the charges and claims and/or turn on Auto Pay.
Changing Charge Dates, Amounts, and adding Auto Pay to a Contract
Once the contract is started the "Start" button appears as grayed out in the upper right of the contract, and the charges will post to the ledger. This can be seen in the two screen shots below.
Once the contract is started, dates will generate based on the first expected charge date or contract start date. Sometimes the dates or amounts must be adjusted. Let's review how to adjust the dates or charge amounts on the RP tab of a contract.
If you need to adjust the "# of payments", you can update the value in that field and then click the calculator button. The contract will automatically recalculate the amounts and dates based on the specified number of payments. In this example, I am changing the number of payments from 12 to 10 and then clicking the calculator button.
Once you select the calculator button, the amounts and dates will change based on the newly calculated contract. In this example of changing the amounts it made the switched the payments from $85.42 a month to $102.50 per month.
In a different example, you may wish to only change the dates. The RP at first wanted the 15th of the month each month, but has now decided to change this to bi weekly. First, change the "Frequency" to bi weekly. Next click on the date to be edited and change it to the correct date and then use the fill button shown in the screenshot below.
*Note: You must have a line selected as the starting place in order to use the fill button.
After clicking the "Fill" button make sure you have it set to affect charge dates and amounts as needed and then click "Fill" to finalize the changes. Always remember to save any changes before exiting the contract.
Sometimes, a practice may receive an EOB after setting up the contract and need to update the claim dates and amounts. On the Insurance tab of the contract, changing the number of claims and clicking calculate will automatically update the claim amounts to match the entered claim count. Alternatively, you can specify a particular date and amount and use the fill button. If the charge date has already passed, it is recommended to first move the funds from "Due now" back to "Future due." An article detailing this process is available here. Once the funds have been transferred back into the contract, you can adjust the dates as necessary.
Note: For the Insurance tab it has a "Form Amount" field as well as a "Ledger Amount" field. "Form Amount" is the amount that is entered on the claim form. "Ledger Amount" is the amount that will hit the insurance ledger when the charge date hits.
How To Add Autopay Payment Method and Autopay Dates
Once you have "Started" the contract, you can add and enable autopay. To set up autopay for a contract, you must have an integrated payment processor. As long as you meet this requirement, you may proceed with the following steps to activate autopay. First, click the "Auto Pay" button located just below the Responsible Party "Future Due" section to initiate the process.
Once that opens, there will be an option for "+Add" to add the new payment method. Click on this first and add the card or bank account information.
Make sure the correct Merchant and Payment Account is selected and bank account or credit card as needed. "EMV" is the correct option if you are using a chip reader and "Keyed" is the correct option if you are entering the card number manually. After selecting the correct options, click the green "Save" button.
Next, enter card or bank account information and the billing address. The next step is to click the "save" or "make payment" option. This will let you know if the card successfully saves or not. After saving the card, make sure to go into the drop down that is marked as "Primary Payment Method" and select the card you have just added. This last step is very important and the drop down must have the payment method selected as shown in the screen shot below. Then click "Ok".
Remember to save your changes. Once the "Auto Pay" method has been added and selected as the "Primary Payment Method", the contract should look something like this:
The check mark on the "Auto Pay" field, as well as the "Primary" payment type ending in *********(last four of card or bank account) lets you know the "Auto Pay" has been added successfully to the contract. Next, The "Auto Pay" columns should be reviewed to ensure all amounts and dates are accurate, using the same tools as those used for verifying/updating charge dates, claim dates, and amounts from above. In the example below, the RP has informed me that they need to pay off the balance over 17 months instead of 15. To update this, I will click on the "# of Payments" field and change it to 17. Then, I will select the first line item and update both the Charge amount and Auto Pay amount to $288.24. After that, I will click the "Fill" button. It will then give the option to fill in both the charge date and amount, as well as Auto Pay details. I will select both options since we are updating the contract with Auto Pay, and then click the "Fill" button.
This will update the contract correctly in all columns. Make sure after making any changes to the contract to save your work.
This was a high level overview of the different sections, fields and drop downs of a contract, and how to create a contract. Below, are some links for some quick reference contract guides you may also review.
Contract Creation Step-by-Step Quick Guides:
Contract with a Single RP Quick Guide
Contract with an RP and Insurance Quick Guide
Contract with Split RP's Quick Guide
Other helpful Contract articles:
How to Write Off a Contract
How to Delete a Contract
As always, if you have any further questions please do not hesitate to reach out to Cloud 9 Support by emailing us at cloud9support@planetdds.com, or chatting us online using the chat bubble on the lower right at https://cloud9support.planetdds.com/hc/en-us, or giving us a call during our business hours of 8:00 AM EST to 8:00 PM EST at the 1.800.394.6050 option 2.