Allowance Table & Bluebook

[li-daniel]

If the Allowance Table & Bluebook reflects $0 insurance payment for fluoride D1208, why does a $ amount still populate when posting this transaction?

[stimmreck]

allowance table and insurance will help to calculate the estimated insurance payment and the patient portion 
while the amount populates in transactions screen is the actual fee for the office ( most probably Fee0 ) that is coming from ( list - ADA codes - search for 1208 then edit - scheduler/Fees tab )

[li-daniel]

Leah,  I am a bit confused by your question.  

You state the FEE schedule and the Bluebook are both marked Zero insurance payment.   You then ask why money is still posting to the ledger.   Please clarify so we may help you better. 

1.) Do you mean to charge the patient at all for service?

2.) Are you contracted with the plan?

3.) Are you indicating that Insurance Money is still posting to the item or Your office fee?  

I bet there is a very easy answer.   

[li-daniel]

1) I want to charge the patient

2) We are contracted with the plan

[stimmreck]

I would check the insurance payment for that code in blue book , it should be 0 

[li-daniel]

1) I want to charge the patient

2) We are contracted with the plan

3) Insurance states it will pay the same amount as the office fee since the

insurance coverage states 100% coverage.

I'm sorry I am making this more difficult.

Thanks

Mary Beth

[li-daniel]

The insurance payment shows 0 in the bluebook & allowance table

[stimmreck]

if insurance is paying 100% of office fee so allowance table fee should = fee0 
and coverage is 100% so bluebook insurance pays should = allowed amount = fee0 
patient pays 0$ and write-off is 0$

[li-daniel]

Ha!!!  Insurance IS difficult!   But easy to manage here.  

If your plan is set up as %PPO

1.)Your ALLOWANCE table should have the allowed amount entered for the code.

2.)ALLOWANCE plan should be added to plan in drop down box on first window of plan.

3.)BlueBook entry should have the allowed amount in the 1208 entry.     

               IF ins were to pay: example:      ins payment   30.00                Fee 35.00 

                                                                 allowed amount 30.00

                                                                  percentage- 100%

             BlueBook entry if Ins does NOT Cover 1208;

                                                                    ins payment;   0.00          Fee 35.00

                                                                allowed amount: 30.00

                                                               percentage cov:   0.00           X(mark the box for upgrade to office fees)

     If the 1208 is simply not covered due to age limitation-  Find the entry in the bluebook and select the tab options and add in the age limitation.   

Your ALLOWANCE table should always reflect the contracted amount- not the amount paid.  Unless COMPANY(not plan) wide it is non-covered service.       

Non-covered services,  if you are in one of the 40 states with non-covered services legislation, you may charge your entire fee for non-covered services.    The patient pays to your fee.   

   *disclaimer-some self-funded or ERISA plans do not honor them as they are federally regulated, however from what I see, most do honor the non-covered services state Legislations.  

[li-daniel]

Hi Melissa,

I tried entering an age limit in the bluebook, entered a 1208 for a patient

over the limit & it still calculated as if ins was going to pay the $25.

The only way I am able to over ride this is putting a X in the box for

upgrade to office (write off applied to patient balance). Does this sound

right? Will I have to do this with all Ins Plans?