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Frequency Limits

Frequency Limits

I would like to see where these frequency limits on cleanings, x-rays, etc could be calculated by SoftDent once we had the plan benefits appropriately checked. Some prophys are 2 x CY, 2 x @12 cons months, others 1 x @ 6 months exact, and the list goes on. There are several procedures I can think of that we could do this for and greatly make our life a little easier.

The ability to have frequency limits per procedure code in the bluebook would be lovely.

preventative codes- 1 or 2 per 6 mo +2 days (leap year), 1 or 2 per Cal year or Benefit year 

FMX/PANO- entry for "no Frequency" and allow us to select numbers 1-12 years

Restorative- once per 12,24,36

Crown& Bridge- Once per 3,5,7,10 years

Ortho- Dependant Cov, Spouse Cov 
I would like to see the information in all possible sites. Some people use the bluebook while another might use a patient tab, in the chart.  When treatment planning, a bluebook note related to limitations or specifics regarding a procedure would be useful before we schedule or plan for that treatment.

I assume you would like this on the insurance plan window - coverage tab - between the percent and wait columns? I'm envisioning 2 columns; Frequency (numeric, 2 digits) and Prep/Seat Date Calc (Alphabetical, 1 character, containing P or S). My concern is that this is not really at the level of detail you're asking for. This tab is showing procedure groups, not individual codes. So we could say Preventive procedures are at 12 months, calculated on Seat date, but we can't specify sealants here.

I think it needs to be more detailed per code than over all Preventative code. I believe it needs to be in the bluebook under the edited code. For example an exam is allowed 3 times a year and a prophylaxis only 2. If you have it under preventative it would be incorrectly calculated. So in the bluebook, under edited code, then under limitations.

7 Comments
ninaclaydental
Canine III

This would be EXTREMELY helpful when collecting for Fluoride and bitewings. Freq limits would be great as an automatic calculation. 2 Thumbs up for this recommendation!  

famdentofcols
Canine II

This would be a great addition to the new version. It is very hard to keep up with all the different age & frequency limitations that insurance companies are using now. 

ktatejacoby
Canine III

In a large practice like ours this would be very helpful, however loading information on group plans is already time consuming and since coverages change all the time you would need a full time person JUST to keep up with all the updates and new loading. Currently, we put all of our information in the notes segment of the plan information. What I would find helpful would be a larger character allotment for this area!

cherring227
Canine III

There are some frequency limitations you can put in the blue book for fl2 and sealants. I agree would love to see an addition to this screen 

ktatejacoby
Canine III

I have a question...what happens in the scheduler when you utilize the limitations in the insurance plan information? In other words, if I add an age limitation for fluoride, when the code is put in the scheduler does a warning come up stating that the patient is over the age limit? If so, that would be very helpful to our schedulers and hygienists to watch for this so they will be able to tell patients if it will be covered or not.

cherring227
Canine III

So when you put in the blue book that fl2 is not covered over the age of 18, nothing happens in the scheduler. Would be awesome if it did, but when you check the patent out, it will put $0.00 as being paid by the insurance so you know to charge the patient. I swear many versions ago, when you put a code in the appointment card, like fl2 or bw a note would pop up saying this code is not covered or allowed by insurance. Idk what happened to that feature, but it needs to come back!

mdunham
Premolar III

Other codes to consider- 

4910

4341

4342

4355