Billing to Medicaid can be a complex and time-consuming process. However, with the right tools at your disposal, you can streamline your billing process and focus more on providing quality care to your patients. We’ll discuss how to utilize the tools in Open Dental to set up and bill to this government insurance program efficiently and effectively.
Initial Setup
Before your practice can really start using these features, they first need to be enabled. Go to Setup, Show Features to enable Medicaid. This turns on several features that your office will need (like the Medicaid ID fields) that are otherwise hidden/disabled.
For each provider who will be billing to Medicaid, you can enter their Medicaid ID by going to Lists, Providers, and double-clicking the provider. This will ensure this information is sent or printed on claims.
This next step is optional but may be helpful for your office, especially if you see a high volume of Medicaid patients. Set the patient’s Medicaid ID as a required field and turn on validation. Setting a required field will show a warning if the field is left blank, but users can proceed if the field cannot be filled out for the patient (i.e. if this doesn’t apply to the patient). Turning on validation ensures that the number of digits in the entered here matches the number of required digits for the entered state.
To turn on Medicaid ID Validation:
- Add MedicaidState to the Required Fields list.
- Go to Setup, Required Fields
- Select MedicaidState from Available fields
- Click the Right Arrow
- Highlight MedicaidState.
- Check Validate the number of digits in MedicaidID to be correct for that state to turn on validation.
- Enter the number of required digits for a Medicaid ID, by state, in Lists, State Abbreviations. A column for Medicaid ID Length is available once validation is turned on.
Tech Tip: If you don’t want a warning to show up for non-Medicaid patients about a missing required field, set a condition for the required MedicaidState field, so a warning will appear “Only If Medicaid ID is not Blank”.
Setting up Medicaid Insurance Plans
Once this is enabled, you can set up your Medicaid/Medicare insurance plans. Setup will differ depending on whether your practice chooses to track write-offs or not.
If write-offs are not tracked, set up the insurance with a Medicaid/Flat Co-pay Plan Type. The Medicaid fee will be billed to the patient’s account with 100% insurance coverage, so there will be no patient portion and no write-off.
If write-offs are tracked, set up the insurance with a PPO Percentage Plan Type with 100% coverage, and assign the Medicaid fee schedule. The office fee will be billed to the patient’s account, the Medicaid fee will be covered 100%, there is no patient portion, and the difference between the office fee and Medicaid fee is the write-off.
Creating a Custom Billing Type
If your practice handles more than just Medicaid patients, you may want to be able to easily separate those accounts out for your cash-pay or conventional insurance patients, so creating a new Billing Type for use with your Medicaid accounts can be invaluable. To do this, just go to Setup, Definitions, Billing Types. Click Add to create the new Billing Type.
When running certain Reports or generating the Billing List (and more), you’ll be able to filter by Billing Type to either exclude Medicaid patients or only include those patients.
We’ll cover how to assign this to your patients in the next section.
Entering Patient Information
In the Edit Patient Information window, you can enter the patient’s Medicaid ID and update their Billing Type. This can be done when first creating the patient from the Select Patient window or at a later time by double-clicking the Patient Info grid from the Family, Account, or Chart Modules.
If you turned on Medicaid ID Validation using the steps we discussed earlier, you’ll get a warning when clicking OK on the Edit Patient Information window that there is a problem with Required Fields if the entered ID doesn’t have the correct number of digits. Click Cancel on the message to return to the Edit Patient Information window to see any errors.
Verifying Medicaid Eligibility and Benefits
When you deal with Medicaid, you know that oftentimes you verify eligibility and benefits for these plans at different intervals than you do for conventional plans. If your practice is seeing patients with both conventional and Medicaid plans, use Insurance Filing Codes to differentiate your Medicaid plans. Once you do, you’ll be able to see those plans split into a separate section in the Insurance Verification List.
To assign Filing Codes, go to Lists, Insurance Plans, double-click a plan, and select the Other Ins Info tab.
Set up your options for the Insurance Verification List, including which Filing Codes show up in the Medicaid List by going to Setup, Appointments, Insurance Verification. In this window, you can also set the default intervals at which patients will show up in the Insurance Verification List to have benefits or eligibility verified.
Once you’ve got everything set up, the main tab in the verification list will display conventional and Medicaid insurance, but Medicaid plans will show up at a different interval. If you assign different employees to verify benefits, you’ll be able to assign users to verify conventional insurance plans in separate tabs from your Medicaid insurance plans.
If you have questions, don’t hesitate to contact us. Our friendly Support Techs are here to help!
Information in this post reflects features available in Open Dental Version 23.1. For the most up-to-date information, please visit our manual.
Categories: Insurance, Managing Revenue, Open Dental