Okay, before I set off on a wild goose chase I would like to ask my SoftDent mentors about the challenge before me.
Here is goes:
We are contracted with an insurance company that has 3 tiers of payment. We are contracted at the highest level, but we are receiving patients in the lower 2 paid tiers. Do I have to make special blue books with the adjusted payments by insurance relative to our max allowable? Can I copy blue books?
Do I make individual allowance tables for each tier?
Also this plan downgrades to amalgams on posterior teeth. :0/
Any recommendations are gratefully appreciated. Thanks.
Solved! Go to Solution.
Thank you for participating in the Community. I'm going to tag a few people on this and get some feedback.
Insurance is going to force me into early retirement lol (just kidding)
I would not use an allowance table for these examples, because you are only contracted for the higher tier, the patient is responsible for the difference. I would use the estimation type Flat Fee PPO and create your blue book. You will have more flexibility using the Flat fee PPO
then you have the ability to copy ble books between plans.
Click Fees Maintenance
Click Copy Blue book between plans
Enter the plan # to copy from & to
Tweak the new plan
We have several plans that do this. Keep an eye on them!
If you are only held to the higher schedules allowable proceed with the following:
1.)Add the Allowance table to the Insurance Plan.
2.) Bluebook will be created. In the bluebook DO NOT CHANGE THE PAYMENT SECTION TO REFLECT THE ACTUAL PAYMENT AS IT WILL CHANGE YOUR ALLOWED AMOUNT, ie your adjustment will be wrong on tx plans and ledger.
Simply go to the percentage box on the tx item within the bluebook and change the percentage to come close to the payment from the plan. Doing this keeps your allowed and adjustment amounts correct. The patients portion may be off a tad here or there, but you are giving an "estimate". Let me know if you need further help.