Question: Our Softdent has never been used correctly. I just took this position 2 weeks ago and I am in charge of updating our allowance tables, bluebooks, and getting insurance to work correctly. We are only in network with 2 companies, and for those 2 companies the allowance tables work fine. My question is when adding an allowance table for out of network insurance companies I am having trouble figuring it out. My understanding was you only need 1 allowance table per insurance company, however, I have found that the allowed amounts are different for every employer and I can't accurately update my allowance tables. Can someone please give me some guidance and advice on this subject.
So basically the allowance table should be attached to the insurance plan. So you maybe have multiple plans (based on the employer) that is under the umbrella of one insurance company. It is very normal that each plan to have their own allowance table.
In those cases, you will have to create a new allowance table for that certain plan by going to List > Allowance table , then add the new plan allowance table. once you finish creating that allowance table , you will need to go to List > Insurance plan > and then attach the newly created allowance table to the plan under the coverage tab.
Now that been said, if the differences between the allowance tables is in one or few codes. You can use the general allowance table you have created and attach it to the plan. Then there is an extra step you will need to do. You will have to go to the Bluebook for the insurance plan in question (the one that has different allowed amount for a certain code). Find the code in question and delete it. After that click Add in the Bluebook screen and enter the correct ADA code information with the correct allowed amount , then click Ok.
So now it is up to you to chose what method you would prefer to use.
Hopefully my answer was helpful.
The plan could be paying under a third party payer. Therefore, simply add your Out of network Allowance Table by the TPP to which has facilitated the claim for the Company.
TPP's frequently drop or pickup new "clients", ie insurance company products over the year or years. The TPP name will be on the EOB as the facilitator of the claim. Each TPP will have their own Allowable that they pay on. (FUN, HUH?)
Note: Not all insurance company products are paid under the same TPP.
Example Only: Employer group DIsney Has Metlife and offers a PDP Plus Network to Employees
Metlife PDP Plus products are TPP networked with Connection in 2018-- D1110 = 65.00
Metlife PDP Plus Products are TPP networked with Careington 2019---- D1110= 52.00
Your Allowance Tables would be set up as **OON- Careington, and **OON-Connection
This would allow you to change Allowance table within Plan if the Product were to drop or change TPP without losing all of your accumulated Fee Data.