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Premolar I

Affordable Care Act Adult/Pedo Policies

I need advice on how to enter ACA policies that have one subscriber with different benefits for adult/pedo family members.

Example:  one primary subscriber/one member id  with one play number

Adult (over the age of 19) preventative covered at 100%

Pedo (under the age of 19) preventative covered at 80%.

I can submit the code D1110 and have it covered in two different ways, with only one subscriber.

2 Replies

Re: Affordable Care Act Adult/Pedo Policies

Hello @kpratt

This type of set up would actually require the office to create a duplicate clipboard and employer/plan profile for the pedo coverage. Making sure to not mark the duplicate clipboard as a patient. Then attaching it as the insurance/policy holder via the pedo patient's insurance information screen. 

The other potential option would be to create duplicates of every code that is covered differently, using abbreviations to make them unique from one another, and then setting up the estimating for each version, using the correct version depending on the patient being seen. 

I'd be more then happy to go over either option with you over the phone. Let me know if you'd like to and we can set up a time. 


Johnathan Downer | Technical Support Analyst
CS Dental Employee
CS Dental Employee

Re: Affordable Care Act Adult/Pedo Policies

Could they create two Employer Plans (Pedo/Adult), setup estimating appropriately, and then switch the Employer Plan when the patient turns 19? That way they have a single clipboard for the patient.