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cabaa99
Canine II

Update Code-specific UCRs for Insurance companies

Hi. The Mass-update Utility will update all code-specific UCRs for employer-specific plans, but it doesn't touch the actual insurance-level code-specific UCRs, even though the first step is to select the insurance companies themselves. How can this be done, aside of manually?

Specifically for Delta Dental, we need many insurance companies entries since they have different mailing address, phone and payer ID for each state. However, the UCRs contracted are the same for all. When a yearly update comes in, we need to modify all of them.  The employer plans tied to each Delta company gets updated, but not the UCR at the each Delta company level.

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Re: Update Code-specific UCRs for Insurance companies

Helle @cabaa99

 

The quick answer to the question is, no.  The utility is designed to update the employer/plan code specific estimating level only. 

 

The explanation/long answer: The estimating inside of PracticeWorks is designed with 7 levels in mind. the first level being the code specific estimating within the employer/plan.  Once it sees information at this level for the needed code, it stops and does not look any further. This makes it so that you cannot have the percentage set up on the employer/plan level and then the UCR setup in the Insurance company level.  Once it would see that 01110 is covered at 100%, if the UCR field is blank here, it will automatically assume it's based on the in office fee as set in the code list. The proper set up would be to have both UCR and percentage set up on the employer/plan's code specific level.  

This basically makes it so that there wouldn't not be a need to enter the estimating information at all in the insurance company code specific estimating level.  The use of the utility is based on the assumption that code specific estimating is set up only in the employer/plan profile, which is considered to be the proper place to input that data. 

The two options you could use would be either to one, go in and manually change all the information. or Two, you can use the copy from option in the estimating window and copy from another insurance company profile or employer/plan that would have the same information inside of it.  But caution on this, the copy from will overwrite UCR and percentage information into it. 

If you have any other questions let me know!

-Johnathan

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cabaa99
Canine II

Re: Update Code-specific UCRs for Insurance companies

Thanks for the detailed answer. We are following the logic of having the UCR and % resolved at the employer/plan specific level, since reality is that it varies per employer.... however, only the % varies, not the UCR.

We could use another employer/plan as the "master" source for the UCR info, but it seems a better approach to use the Insurance level for that, since since they are fixed per insurance company, and the ins company is really that Master (That's why my original question). When adding a new employer/plan, we copy the code-specific info from the insurance level, and manually overwrite the default % coverages to what that plan needs (in reality, we keep 2-3 ins-level copies with different default % to ease this process)

Here's where we could use an improvement in the copy function: to not overwrite the %, so we can easily refresh the UCRs at a plan-specific by copying from an insurance-level, without having to redo the plan-specific %s. The closest to this is the mass-update option we are talking about, but that still requires us manual updates on the insurance-level tables.

The%

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