We are working with some PACE programs. We are paid on a capitated model with exceptions (new denture, etc.) Can someone help me understand setting up a capitated plan, how it effects our reports and what the patient sees on their treatment plan.
Thanks for contacting support. The insurance plan's estimation type should be set to DMO/Capitation to post insurance plan payments directly to the insurance plan. Here are the steps:
1. Click List in the main menu bar.
2. Select Ins Plan.
3. Double-click the appropriate insurance plan in the list.
4. Select Transactions from the options menu or options bar.
5. Click Add.
6. Enter the appropriate check information such as amount, check number, and any notes.
7. Click OK.
8. Click Close on the Plan Transaction window.
9. Click Close on the Plan Transaction list
As far as the reports are concerned, the amount that you enter as a payment from that particular DMO plan, it will reflect an additional production amount on your daysheet and registers report. The treatment plan only shows the estimated amount that may be paid/owed for future treatment and will not reflect any DMO payments on the Treatment Plan.
Thanks Robert for this explanation. So we are paid a flat rate, per member, per month. The only thing that is billed out separately is new dentures and partials. Will this work for that? Will the URC fee amount show up on the Production by ADA report? I have to produce reports showing the amount of dentistry completed at UCR. Thanks for helping me work through this one.
Here are some other tips for you. Create a blue book for the DMO/CAP plan. This will reduce the number of insurance adjustments you will need to make when posting insurance payments.
The Monthly CAP check gets posted to the plan, the claim checks get posted to the patient for the denture etc.
Under the system/fees maintenance, use copy blue books between plan to make it easier to set up the next DMO/CAP plan
Under system/change system settings turn on Turn on show ucr on bills, tx plans walkout statements(it will show the blue book amount in the fee with a new line underneath showing what it would be at full fee.
Let us know if you have any questions.