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Sherij
Canine II

Insurance Fee Schedules in Ortho Trac

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Hi, 

I work with a practice that participates in many plans and we have different fees for the same insurance per insurance company.   Currently we are using a list to go off of when we make a contract but I'm wondering if we can add the fees in by employer or insurance company into orthotrac?  Maybe the discounts? Help!   I know I can do it in softdent but I'm not seeing it in ortho trac.  

 

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prcarter
Moderator
Moderator

Re: Insurance Fee Schedules in Ortho Trac

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Good day Sheri ( @Sherij ),

I'm not quite sure whether you're talking about a single insurance company having multiple different fees for the same procedure, or whether you're talking about a single procedure code which is charged a different fee based on who the patient's insurance carrier is.  If a specific insurance carrier has limits for coverage / fees for a specific procedure code, you can set that using the Coverage button for that carrier in Carrier Maintenance:

1. Select Functions > Maintenance/Set-up > Carrier Maintenance from the menu bar.

2. In the CS OrthoTrac Carrier Lookup window, select the carrier and click Change. The Carrier Maintenance window is displayed.

3. Click Coverage. The Insurance Coverage window is displayed.

prcarter_0-1614365833499.png

4. Click the Lock icon in the right corner of the window to set the status of this carrier to Locked or Unlocked.

IMPORTANT: The Lock icon controls whether changes made to your procedure codes apply to the selected carrier. If you edit your procedure codes and then make a global change, the changes do not apply to any carriers you have locked.

5. Select the Coverage Type for this carrier by clicking one of the option buttons.

Variable — The carrier pays different percentages for different procedures; for example, 100% for records, 80% for exams, 50% for treatment.

Fixed — The carrier pays the same percentage for all procedures; for example, 50%. If you select Fixed, enter the percentage amount, and the software assigns this amount to all procedures.

If most of the procedure codes should be the same percentage, select Fixed and enter the percentage amount to automatically set the same percentage for all procedures. Then select Variable and change the codes that require a different percentage.

6. Select the first procedure code that you want to edit for this carrier and enter information in the columns.

ADA — The ADA code assigned to this procedure.
Fee — The doctor’s charge, posted to the responsible party’s ledger.
Ins — The amount printed on the insurance claim, which is the maximum amount the carrier pays. This amount can never be more than the doctor’s fee.
Coverage — The percentage of the charge the carrier actually pays. If you selected Fixed and entered a percentage, the Coverage column is automatically populated and cannot be changed.

7. After entering the amounts for all of the procedure codes, click OK.

 

Hopefully this answers your question.  If it does not, please contact Support directly at 866-722-2567 with additional details and we will be happy to assist you further. 

Regards,

Phil Carter / OrthoTrac Escalations

 

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Sherij
Canine II

Re: Insurance Fee Schedules in Ortho Trac

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I need to correct my question.   The insurance companies have different maximum allowable fees per procedure.  so like D8080 is a different price to the patient depending on the plan.   

 

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prcarter
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Re: Insurance Fee Schedules in Ortho Trac

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Good day Sheri ( @Sherij ),

I'm not quite sure whether you're talking about a single insurance company having multiple different fees for the same procedure, or whether you're talking about a single procedure code which is charged a different fee based on who the patient's insurance carrier is.  If a specific insurance carrier has limits for coverage / fees for a specific procedure code, you can set that using the Coverage button for that carrier in Carrier Maintenance:

1. Select Functions > Maintenance/Set-up > Carrier Maintenance from the menu bar.

2. In the CS OrthoTrac Carrier Lookup window, select the carrier and click Change. The Carrier Maintenance window is displayed.

3. Click Coverage. The Insurance Coverage window is displayed.

prcarter_0-1614365833499.png

4. Click the Lock icon in the right corner of the window to set the status of this carrier to Locked or Unlocked.

IMPORTANT: The Lock icon controls whether changes made to your procedure codes apply to the selected carrier. If you edit your procedure codes and then make a global change, the changes do not apply to any carriers you have locked.

5. Select the Coverage Type for this carrier by clicking one of the option buttons.

Variable — The carrier pays different percentages for different procedures; for example, 100% for records, 80% for exams, 50% for treatment.

Fixed — The carrier pays the same percentage for all procedures; for example, 50%. If you select Fixed, enter the percentage amount, and the software assigns this amount to all procedures.

If most of the procedure codes should be the same percentage, select Fixed and enter the percentage amount to automatically set the same percentage for all procedures. Then select Variable and change the codes that require a different percentage.

6. Select the first procedure code that you want to edit for this carrier and enter information in the columns.

ADA — The ADA code assigned to this procedure.
Fee — The doctor’s charge, posted to the responsible party’s ledger.
Ins — The amount printed on the insurance claim, which is the maximum amount the carrier pays. This amount can never be more than the doctor’s fee.
Coverage — The percentage of the charge the carrier actually pays. If you selected Fixed and entered a percentage, the Coverage column is automatically populated and cannot be changed.

7. After entering the amounts for all of the procedure codes, click OK.

 

Hopefully this answers your question.  If it does not, please contact Support directly at 866-722-2567 with additional details and we will be happy to assist you further. 

Regards,

Phil Carter / OrthoTrac Escalations

 

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