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mbusinelle
Premolar I

Insurance benfit table

We have an insurance that we are contracted with that pays a set fee, but we also have to write off the difference in the contracted prices.  When I am setting up my table, Patient payment method is #2, Insurance payment method is fixed price, but it will not let me put in UCR max fee considered.  I need this to still write off the difference in the fee schedule pricing.  Any thoughts?  So for instance, the total fee is $25.00, the insurance pays $8.00, the contracted fee is $21.00.  I need the update to show the part the patient owes of $13.00.  Right now it updates that the patient owes $17.00.  Is there a way around this or no?  Maybe I could do something different?  

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6 Replies
tshaw
Community Manager
Community Manager

Re: Insurance benfit table

@jdowner @tsalcido @jfdias68 any suggestions? 

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tsalcido
CS Dental Employee
CS Dental Employee

Re: Insurance benfit table

Set up code under #3 PPM (Patient Payment Method) with the amount the patient will pay; set up IPM (Insurance payment method) with what the amount insurance will pay. ( see below)

 

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Results:

Treatment plan breakdown

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Check out Ledger break down

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mbusinelle
Premolar I

Re: Insurance benfit table

Yes that works, but with 100 dental codes thats alot to go through and have to figure what the patient will pay, when we should just be able to put in the max fee considered and the computer automatically figure it.  maybe something to consider for the future.  

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tsalcido
CS Dental Employee
CS Dental Employee

Re: Insurance benfit table

PracticeWorks Code specific estimating does do the math at the precentage rate with the Insurance UCR entered. If you are dealing with downgraded fees then you will need to do the math to figure what is the precentage actually being paid for the procedure.

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kellycacc
Canine III

Re: Insurance benfit table

Some fees are downgraded only on specific teeth. For example code 2740 may be downgraded on a molar but not on a premolar or an anterior tooth. How can I enter that info so the estimating is correct?

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tsalcido
CS Dental Employee
CS Dental Employee

Re: Insurance benfit table

You can enter the a duplicate ADA code. Use a unique abbreviation when creating it. It wll be the same code, same fee,  different abbreviation.

To create a duplicate code go to the Transaction code list and create. 

My oringal code

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My duplicate- I put in the same abbreviation with a D for downgrade

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Then go to the Bluebook and enter in downgrade info. 

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In summary when checking out a patient or creating a treatment plan for the specific tooth always select your second code.

One more thought---

Creating duplicate codes means that in the charting they will get a prompt to choose a code. It is normally in order of creation. So the orignal ADA will be the first option and duplicate will be second. 

A prompt when entering a treatment plan-

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