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hygiene clinic setup


Instream is the iTrans for hygienists and denturists. The set up is very similar:
 

  1. The new hygiene practice needs to register with the CDHA
  2. The CDHA will provide a unique ID (starting with 202)
  3. Then the hygienist needs to enroll in electronic billing (the form is found on the CDHA site)
  4. They also need to enroll with Instream by completing a form and paying a yearly $180 fee
  5. They need to install the Instream communications agent (version 4.1) onto their machine
  6. They will get a digital certificate that they need to install on their machine
  7. ABELDent needs to upload the hygiene claim form onto the workstation as well, note that we have the Summer 2020 version (see attachments)
    developed but not the Nov 2020 (which is only slightly different, and should not make a difference at this time)

Setting Up a Hygiene Clinic to print Hygienist Claim Forms

E-claims and Supported Transactions
This document is designed to give greater insight to the current e-claims capabilities of carriers, and e-claims specific contact information for the dental hygienist. Please note: instream and TELUS
networks currently support each others’ transmissions with a bi-directional interchange. Provided you have chosen and registered for ONE of these networks, you will be able to submit e-claims to all
carriers on both networks.

https://files.cdha.ca/Profession/IP/E-Claims_Support_January_2022.pdf

Carrier Contacts and Claims Support
This document provides manual claims submission information, as well as provider specific contact information. Additional information specific to online provider portals and fee grids have also been provided.

https://files.cdha.ca/Profession/IP/Carrier_Contacts_January_2023.pdf

Sun Life Email Claims System
You can now email your insurance claim forms directly to Sun Life for processing. No more waiting on traditional mail. This will speed up processing time, reduce errors and have reimbursement in yours or your client’s pockets faster!

https://files.cdha.ca/Profession/IP/Sun_Life_email_claims_EN.pdf

 step 1

  1. Navigate to folder [drive letter]:\ABELDent\MASTSPEC\GDI
  2. Copy the three files HygInsForm.bmp, HygInsForm.spe and HygInsForm.wmf into this folder.
  3. Rename each of the following three files in this folder as follows:
    1. Rename insform.bmp to DrInsForm.bmp
    2. Rename insform.spe to DrInsForm.spe
    3. Rename insform.wmf to DrInsForm.wmf
  4. Rename the three files copied here in Step 2 to remove the letters “Hyg” at the beginning.

Step 2

  1. Navigate to folder [drive letter]:\ABELDent\ENV\GDI
  2. Copy the one file HygInsForm.spe into this folder.
  3. In this folder, rename insform.bmp to DrInsForm.bmp.
  4. Rename the file copied here in Step 6 to remove the letters “hyg” at the beginning.


From now on, when this office prints an Insurance Form, it will be a Canadian Dental Hygienist Association Claim Form not a dentist claim form.

 

CDHA Form Configuration

Procedures to accommodate using the new CDHA national dental hygiene claim form, English only.

Requires ABELDent 8P03+


Notes:

  1. Hygienist(s)/owner whose name should appear on the form needs to be configured into the Provider File similar to the configuration used for a dentist, i.e. professional provider name,  id number and activation code must be defined. Responsible provider must be blank. Track receivables should also be set accordingly.
  2. Practice providers working for this Hygienist/owner(s) can be configured as hygienists typically are in the provider file inserting the Hygienist/owner provider letter into the responsible provider field. Usual billing rules apply and should be defined.
  3. All providers will be required to use the Standard Dental Claim form for Predeterminations


Option 1
Hygienist/ owner and any potential additional hygienists but NO associate dentists in the practice.

Post update to 8P03, perform this procedure on each computer installed with ABELDent:
 
  1. Navigate to c:\abeldent\env\gdi\folder
  2. Rename insform.spe to drinsform.spe
  3. Rename hyginsform.spe to insform.spe

On the server computer only:
  1. Navigate to c:\abeldent\mastspec\folder
  2. Rename insform.spe to drinsform.spe
  3. Rename insform.wmf to drinsform.wmf
  4. Rename insform.bmp to drinsform.bmp
  5. Rename hyginsform.spe to insform.spe
  6. Rename hyginsform.wmf to insform.wmf
  7. Rename hyginsform.bmp to insform.bmp
  8. Open Abeldent
  9. File, Update, System Setup.
  10. At the bottom of the General tab, select option to use the Standard Claim form for Predeterminations. Click OK.

Bill using the appropriate provider and/or Hygienist/owner(s). Insurance forms will print on the CDHA national dental hygiene claim form. Preauthorization’s will also print on the CDHA national dental hygiene claim form with the 'Indicate if Preauthorization' flag set on and no date of service for services listed.

Option 2
Hygienist/owner with associate dentists in the practice

Setup A

Dentist forms are printed from a specific workstation(s) and Hygiene forms are printed from different and specific workstation(s).  Workstations where the dentist forms are to be printed will not require any changes. 
. 
Hygiene workstations will need to be configured as follows
 
  1. Navigate to c:\abeldent\env\gdi\
  2. Rename insform.spe to drinsform.spe
  3. Rename hyginsform.spe to insform.spe
  4. Navigate to c:\abeldent\mastspec\gdi
  5. Rename insform.spe to drinsform.spe
  6. Rename insform.wmf to drinsform.wmf
  7. Rename insform.bmp to drinsform.bmp
  8. Rename hyginsform.spe to insform.spe
  9. Rename hyginsform.wmf to insform.wmf
  10. Rename hyginsform.bmp to insform.bmp

On the server computer only:
  1. File, Update, System Setup.
  2. At the bottom of the General tab, select option to use the Standard Claim form for Predeterminations. Click OK.

Bill using the appropriate provider, dentist and/or Hygienist/owner(s). Insurance forms printed will print on either the CDHA national dental hygiene claim form or the CDA Standard dental claim form depending on the station where the print job is requested ie: A Dentist’s form station or a Hygiene form station . Preauthorization forms for both Dentist and Hygienist will print with the 'Indicate if Preauthorization' flag set on and no date of service for services listed.

Setup B

This setup will allow the office to print either a Dentist claim form or a Hygienist claim form from any workstation.  The user will be prompted when printing an Insurance form to select the Hygiene form (yes) or (no) to use the Standard Dental claim form for any dentists in the practice.  This setup cannot be used if the office has any assigned form id’s, ie: PBC in BC and sometimes ABC in Alberta.  If they do they must configure using Setup A 

On the Server:

Update ENV and MASTRSPEC
  1. Navigate to c:\abeldent\env\gdi\
  2. Rename hyginsform.spe to hygform.spe
  3. Open the hygform.spe in notepad and edit the PRE line to read PRE mastspec/gdi/hygform.wmf
  4. Navigate to c:\abeldent\mastspec\gdi\
  5. Rename hyginsform.spe to hygform.spe
  6. Rename hyginsform.bmp to hygform.bmp
  7. Rename hyginsform.wmf to hygform.wmf
  8. Open the hygform.spe in notepad and edit the PRE line to read PRE mastspec/gdi/hygform.wmf

Run script to populate the ASSIGNED FORM ID field in the Plan
  1. Navigate to c:Abeldent\bin\
  2. Open abelscript.exe
  3. Run Script
UPDATE nsp SET nformid='STDIFORM' WHERE nformid = '' OR nformid IS NULL

Setup Form id STDIFORM to use Hygform.spe
  1. Open Abeldent
  2. Navigate to File\Update\Insurance\Forms
  3. Select STDIFORM from the list
  4. Edit the Specification file to HygForm.spe
  5. Edit the Description to Hygiene Insurance Form
  6. Printer should be set to 1

On the server computer only:
  1. File, Update, System Setup.
  2. At the bottom of the General tab, select option to use the Standard Claim form for Predeterminations. Click OK.


When treatment is entered for the Hygienist that requires a CDHA claim form, the user will select Yes at the Non – Standard Insurance Form Printing dialogue to print the Hygiene Insurance Form.  If a dentist requires the standard dental claim form, the user will select No to print the standard dental claim form


Only select carriers process claims electronically with Instream. See the list here:

https://instreamcanada.com/instream-carriers/
 
Another very helpful document I like to provide clients, regarding eClaims:

https://files.cdha.ca/Profession/IP/E-Claims%20Support%20May%202021.pdf
https://files.cdha.ca/Profession/IP/Carrier_Contacts_Dec2019.pdf
https://files.cdha.ca/Profession/IP/Sun_Life_email_claims_EN.pdf
 

Keywords: hygiene clinic setup hygiene practice denturist