Most SD users are frustrated with the inaccurate and tedious Insurance collection and Adjustment Reports. My suggestion is to either create a new set of reports/ or correct the current "Contractual Insurance Company Production" (and the complimentary adjustment report) to pull the report data from the ALLOWANCE table to which a PLAN is attached.
The reason I suggest such a report is the following:
1.) Company Network Products are often leased to TPP(third-party payers) and would allow an office to view their production/adjustments for contracted TPP's. It is currently difficult and almost impossible to perform this within SD.
2.) Companies often have different claims address and Company names. Example: Delta Dental as a company will have different addresses for commercial products written within states, ie, Delta Dental of MI, CA, etc. My suggestion would allow all of those plans to be included on one report because the Delta Dental Allowance table would be attached to those plans.
3.) Company Network Products can switch or drop participation with a TPP. Because these network arrangements are not COMPANY wide. Example: United Concordia Advantage plan drops participation with Careington TPP and elects to join Connection TPP. If a DDS is not participating with UCCI PPO, but has an agreement with Connection, the DDS is now "in network via Connection" for pts with UCCI Advantage. Currently, SD only allows for the PROD/ADJ data to be pulled via Company/ or Plan. A report, per Company, ie in this case; Connection, could not be used, because the claims for TPP's are not handled by the Contracting Company, ie, Connection/Careington /DHA/ Principal/ etc. Claims are handled by the Company in which has the leased network, ie; Cigna would handle claims for Cigna Advantage and not the TPP.
4.) Cross-Networking contract arrangements: Very often DDS are contracted with multiple TPP's and negotiations upon signing allow for a provider to collect the highest of their schedules between cross-networked products. Example: DDS has an agreement with Careington and Connection wherein the DDS has a higher allowance with Connection. Cigna Advantage is cross-networked with Careington and Connection, the provider will use the Connection Schedule for Cigna Advantage products due to his higher allowance negotiations. If Cigna Advantage pulls participation from Connection now the Careington Schedule would apply.
Questions to ponder:
1.) When pulling report data based upon allowance table added to plan. How would this effect report data when an allowance table is changed during a reporting time frame?