Frequency Limits

Idea created by Matt Ackerman Employee on Jul 17, 2017
    Active
    Score65

    I would like to see where these frequency limits on cleanings, x-rays, etc could be calculated by SoftDent once we had the plan benefits appropriately checked. Some prophys are 2 x CY, 2 x @12 cons months, others 1 x @ 6 months exact, and the list goes on. There are several procedures I can think of that we could do this for and greatly make our life a little easier.

    The ability to have frequency limits per procedure code in the bluebook would be lovely.

    preventative codes- 1 or 2 per 6 mo +2 days (leap year), 1 or 2 per Cal year or Benefit year 

    FMX/PANO- entry for "no Frequency" and allow us to select numbers 1-12 years

    Restorative- once per 12,24,36

    Crown& Bridge- Once per 3,5,7,10 years

    Ortho- Dependant Cov, Spouse Cov 
    I would like to see the information in all possible sites. Some people use the bluebook while another might use a patient tab, in the chart.  When treatment planning, a bluebook note related to limitations or specifics regarding a procedure would be useful before we schedule or plan for that treatment.

    I assume you would like this on the insurance plan window - coverage tab - between the percent and wait columns? I'm envisioning 2 columns; Frequency (numeric, 2 digits) and Prep/Seat Date Calc (Alphabetical, 1 character, containing P or S). My concern is that this is not really at the level of detail you're asking for. This tab is showing procedure groups, not individual codes. So we could say Preventive procedures are at 12 months, calculated on Seat date, but we can't specify sealants here.

    I think it needs to be more detailed per code than over all Preventative code. I believe it needs to be in the bluebook under the edited code. For example an exam is allowed 3 times a year and a prophylaxis only 2. If you have it under preventative it would be incorrectly calculated. So in the bluebook, under edited code, then under limitations.