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ShannonB
Canine II

Deductible and downgrading

I am hoping we can get an update on the blue book feature. Whenever an insurance downgrades, we set the blue book up so that it is 'set pt and set insurance payments.' However, the system will not calculate the deductible when this happens. A lot of delta plans have deductibles and downgrade their posterior composites. It would be great if we can get the deductible to apply to these somehow.

I have a note to print out on estimates to calculate the deductible when applicable but no one reads these and patients get upset that we give them the wrong estimates.

Does anyone else have this problem?

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jdowner
Moderator
Moderator

Re: Deductible and downgrading

For downgraded codes where a deductible applies I suggest using one of our other methods for estimating downgraded codes. 

Assuming the code is 2391, at least for the example. 

An office can create a duplicate 02391 Tx Code on the tx code list entering the downgraded UCR fee as the duplicate's Fee 1. 

Note: For the duplicate code to be considered a separate entity in the software, it must be given an abbreviation; otherwise, the software will still pull the office fee and estimating from the original code.

At this point, you can go into the code-specific estimating for the needed plans and select the #2 option under "Patient payment method," and enter the percentage. You can leave the UCR field set to 0 so that it bases the percentage off the "Office fee" that was set in Fee 1 for the tx code. 

With this setup, you can check the box for the deductable to apply. 

 

If you have any questions fell free to reach out to support and we'll be happy to assist. 

 

Johnathan Downer | Technical Support Analyst
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sonyap
First Molar I

Re: Deductible and downgrading

We do what @jdowner suggested - we have two identical codes for each posterior composite restoration.  One says molar, one says bicuspid.

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