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kpratt
Canine III

Preventive/Diagnostic not counted toward Yearly Max Benefits

Some insurance plans do not count preventive and diagnostic procedures toward the yearly maximum.  How can I set up Practice Works to calculate the yearly maximum correctly if preventive/diagnostic procedures do not affect the yearly max?

 

 

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7 Replies
sonyap
Premolar III

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

You can't

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Moderator
Moderator

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

As Sonya said, there isn't a way to keep some codes from counting towards the benefits. We do not have a work around for this either. Outside of keeping track of it manually and correcting the benefits used box as you go. 

Johnathan Downer | Technical Support Analyst
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sonyap
Premolar III

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

Maybe in a future version, in the employer's benefit table, you can make a column for "maximum applies" just like you have one for "deductible applies"?

Moderator
Moderator

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

probably wouldn't be a bad idea.  either on the table, or in the code specific to mark certain codes as not applying to the used benefits in some way. 

@tyson_edwards  - Something to consider

Johnathan Downer | Technical Support Analyst
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MFJdentists
Canine II

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

Our office is just getting started utilizing PracticeWorks to actually estimate benefits. I really like Sonya's idea of a check box column for this versus doing for specific codes.  

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carolyn621
Premolar I

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

That might be a work around although it is a terrible system because even with the yellow stickies there are only so many characters. To be truly accurate, the dates of service would need to be included. And this doesn't take into account any benefits used by specialists - which is always fun when estimating for the treatment. If no one was ever in-network then it wouldn't be an issue. Come on - would it really be hard to create a check box like currently utilized for the deductible and if the procedure was exempt from the annual max, check the box. 

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MAV
Canine II

Re: Preventive/Diagnostic not counted toward Yearly Max Benefits

any news on whether this fix is in the works?  

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