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Canine II

Changing the way we do things with insurance

We are going to switch from billing out the contracted PPO rates to billing out the UCR rates for all patients. What is the best way to be able to still quote our patients quickly...Allowance tables or Blue Books? How do we do a treatment plan and have it show our UCR and the insurance allowable amount and then do the % of that to show the patient what their portion will be?

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First Molar I

Re: Changing the way we do things with insurance

BOTH!!   Use Both the Allowance Table and Bluebooks.          ALSO Congrats!!!  Your practice will see an income increase as your practice will now process to it's Fee. This is especially critical when filing Dual Coverage. 

     Also! It's very easy!     SD can be very accurate when you understand HOW SD thinks.   

    HINT: SD will calculate ANY adjustment to the PRIMARY plan indicated on the PATIENT SCREEN.  ( No adjustment on Primary, none will be calculated on Second -which could be incorrect if you are contracted w/ secondary plan)  Also, SD will calculate adjustment and patient portion based on amounts in BlueBook first and THEN the plan estimation %'s or Waiting period times, etc.  If there is nothing in Bluebook, it will revert to basic info in Plan tab.  


Step One:   Remove the auto-adjustment selection from within the plans. This button is in the lower left of the insurance plan.   I believe there is a utility for this that can be done on your server. Contact Support.   

Step Two:  Enter ALL ALLOWANCE tables into SD by CONTRACT ( not by the company) ie, if you are a third party contracted.  Example:  United Concordia Allowance Table would be applied to some Blue Cross plans/Carefirst plans. etc.  

Step Three:  Erase All existing Bluebooks via Utility.  

Step Four:   Add Percentages, Waiting Periods, FMX/Pano Freq, and Calculation Method into Plan.  

Step Five:   Add Allowance Table associated with the Plan.  (this must be done after %'s. wp's etc, otherwise, the wp's and freq may not apply to the bluebook, they must be entered before Allowance Table is added) 

Tx pLans will now display, your fee, calculated adjustment, and patient estimated portion.   Ledgers will do the same.  


In the event you owe the patient an adjustment that is not calculated ( ie, the secondary adjustment is higher than the primary)   You must do some quick math.    Simply subtract the amount shown as an adjustment in the Transaction tab, from the actual adjustment of Secondary, and apply the difference as an adjustment type.  You can Create one called "COB" Adjustment-   

Example:   Practice fee: $ 200.00 

                  Primary Allowance: $ 125.00

                  Primary Paid:$ 45.00      Primary Calculated Adjustment is: $75.00

                  Secondary Allowance: $120.00

                  Secondary Paid:  $75.00

                  COB ADJ Owed:  $5.00 


If Secondary Allowance is Higher than Primary,  SD subtracts the estimated payment from the Secondary Allowance and enters that number as the estimated secondary payment, and never causes an issue, as the payment is estimated as more. 




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