I'm trying to research all insurance company's and its a HUGE mess
I have been doing this for years but insurance is changing and I'm so confused
on what to do next I could use any help you could provide I'm still trying to set up delta dental
that and Cigna the only insurance we are participating with but we file all insurance for our patients
hank you Beth Whittington
Beth, I generally go to the Ins Company website and download the Dental Reference Guide. The Dental Reference Guide is a descriptor on how the Ins Company will determine payment for procedures, frequencies etc.
You can create a BlueBook for each Ins Comp and then copy to new created Blue Books.
For instance, I have created a dental plan labeled UCCI PPO DEFAULT, then I create a bluebook, (if contracted add your allowance table to plan first) . Then enter all procedure code specific information in the note section of each code,ie D4346- note- will not be paid within 6 months of 4341/4910, or D6243-(interim pontic)- interim prosths are not covered, no adjustment.) etc., or this company will downgrade to Partial if pt is missing more than 3 teeth in full arch.
If you have a plan in which the frequencies have been negotiated slightly different, for instance, D4346 is not covered. simply edit that in your newly created bluebook, the other information should apply.
Why do this? A: every note that you apply in the bluebook will pop up when posted into the tx plan, ledger etc. Obviously, this cuts down on your hyg team from either having to look up a procedure code frequency or asking front desk team. Secondly, this information can be known by your treatment plan coordinator upfront when treatment planning patients, your office looks pretty amazing to patients. HA!
It does take some time upfront, but save alot in the long run. I download new DRG's every year and keep them on file for 3 years. The perk is that you can technically do this for all plans, contracted or not.
TIP: Be sure that you only enter Ins COMPANY terms and not those of a plan within that company, or your information could be incorrect throughout. If you need help, give me a shout.
This site is extremely useful for everyone, as there are some great minds on here. Jessica Lingle is completely on point with her efforts.
I am going to tell you what I have learned about dental insurance networking and try to speak to what you have to understand from the very beginning. Please disregard if you already know these things but they were helpful to me!
1) Your doctors are contracted or "preferred providers" with dental networks not insurance companies. The terminology is very important to understand when trying to get info out of insurance companies on the phone.
2) Find out what dental networks your docs are contracted with. (I did this a back door way by calling insurance companies and asking what network they paid us through).
3) Insurance companies 'rent' dental networks. Some insurance companies own their own network and some do not. Some insurance companies rent multiple dental networks and will pay you based on the network that you have contracted with that pays the least (saves them money). For example, Blue Cross Blue Shield uses many dental networks- Dental Network of America/Maverest/Connection Dental, etc. If you are contracted with any of the dental networks, you are a preferred provider for BCBS. BCBS does not have it's own dental network so DO NOT title an allowance table BCBS or you will never get all this figured out.
4)Google the dental network's provider service number. Call them and request a current fee schedule (aka allowance table) and a client list. Start by adding the allowance table and title it by the network name. For example if you are contracted with Dental Network of America (DNOA), title that allowance table as DNOA. Then if you have Blue Cross Blue Shields plans that are paid via DNOA--you will use the DNOA allowance table when creating a BCBS insurance plan.
5)Bluebooks are a different animal than allowance table but are super important. The fastest way to start fixing errors is to set up your posting preferences to update the blue book when posting. This way, anytime you get a payment that is not paid as expected, SD prompts you to correct that specific code to be estimated correctly the next time.
6) Other notes--- sometimes the same dental networks go by different names. For example, Connection dental is also known as PPO USA. They try to keep things simple that way!
I could type forever on this subject. I have a 2 hour presentation I do to teach how to navigate insurance contracts. And its always changing! Let me know if you have any questions.
Your post was exactly what I was looking for. Could you please tell me how I can gain access to your presentation? Thanks.