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irobert1208
Canine II

UCR & WO

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Is their a way not to do WO before getting an EOB and also a way to enter insurance fee instead of UCR for patients who are in NETWORK?

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sonyap
Premolar II

Re: UCR & WO

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I'm not sure I understand the first part of your question, and I need to get clarification on the second part.  Are you saying you want to enter the insurance payment amount instead of a UCR amount in the blue book for in-network patients?

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Moderator
Moderator

Re: UCR & WO

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Hello Irene

If I'm understanding your question correctly. you are wanting to know if there is a way to set up estimating in a way that will allow you to enter in the UCR (insurance fee) in the code specific estimating section and not have it automatically apply the write off.

Assuming that is what you want for now, you have two potential options.

1) You can leave the option for the Patient Payment Method as option 1. This will make it so that PracticeWorks will not expect there to be a write off to be applied. The downside to this is that if you are planning to put in a write off at the time of payment, then this option will not take that into account and it will assume the patient owes anything not covered by insurance (calculated from either the percentage or fixed amount entered) and the statements and aging bar will reflect this showing that the full amount up to the in office fee is owed by the patient, with exception of what is expected to be paid by insurance.

Code specific Estimating showing Patient payment option 1

2) You can leave it the Patient Payment Method as option 2. This will cause the system to expect the automatic write off of any amount above the UCR (insurance fee), which will trigger the automatic write off code that is set by the office on the Benefit Table screen of the estimating. If you clear the option for the "Adjustment code to use for automatic write-off of amounts in excess of UCR" it will not apply the automatic write off. However, you will get a warning message every time you go to check out a patient that uses that Employer/plan's estimating. The warning basically states that it is set to use an automatic write off but one is not assigned to be used. You can click OK on the warning and bypass it and this will keep the write off from applying as well. But it will allow TX plan to still include the write offs where needed.

Benefit table w/ auto write off

If you have any additional questions about this please let me know.

-Johnathan

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sonyap
Premolar II

Re: UCR & WO

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We have another work-around.  We leave patient payment method as option 1.  We don't post anything in the blue book for "adjustment code".  What we do is add the write-off to the insurance company payment, and enter it in "code specific estimating" as 100%.  For example:  If our prophy fee is $100 and Delta allows $80 and pays 100% of that, we take the $20 wo, add it to the $80 payment, and our D1110 code reads $100 @ 100%.

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CS Dental Employee
CS Dental Employee

Re: UCR & WO

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This is one of the benefits of activating Line Item Accounting in Version 8. The write offs are not posted at checkout. Rather, a new column is added to the aging grid on the ledger and the estimated payment reduces the patient's balance. When the EOB is received the insurance payment is entered along with the write off. This way the write off is applied to the proper procedures and posted to the ledger for the exact amount on the EOB. 

I'm not sure about the following: "way to enter insurance fee instead of UCR for patients who are in NETWORK?" Can you elaborate on this?