Which Estimation Type should I choose?

[loretta_smith]

I am having trouble with the Estimation Type for an insurance plan that i am trying to add. I referenced a document and it clearly covers a step by step process but i am having trouble with the first step......Selecting an Estimation Type.

• Flat Fee
• Percentage
• DMO/Capitation
• %PPO
• Flat Fee PPO

Plan info: Blue Cross/Blue Shield DHMO. Dr. is an In-Network Provider (No Capitation). The fee allowance on MOST procedures is 80% of the UCR which means we accept a 20% write-off on MOST procedures. I have the max allowable charge for each procedure not included in that 80% .  I also have the plans benefit details and the patient co-pay schedule for each covered procedure.

So i have all the info but i can't plug it in correctly and I believe my first mistake is not selecting the right estimation type for the bluebook tabs that i need to see, i.e Fee.Copay.Plan Fee. ins. Pymt and a write-off........Please Help.

SoftDent: Editing Bluebook Entries‌tshaw

[robert_martin]

Thanks for contacting us. In order for the allowance table option to populate (so that a Bluebook can be automatically created) Please be sure that your estimation type is one of the following:

• Percentage
• %PPO
• Flat Fee PPO

[wesley_barron]

Hello Keisha,

For the plan you described:

• Does the insurance plan specify an allowed amount for covered procedures?
• Does the insurance plan pay a percentage of this allowed amount?
• Does the patient pay the difference between the insurance payment and the allowed amount?
• Is the difference between the allowed amount and your UCR (Fee 0) written off?

If the answer for all four of these questions is "Yes," the estimation type for this plan should be set to "%PPO" (short for Percentage PPO). By selecting "%PPO" as the Estimation Type, bluebook entries on the plan will display the following fields:

• Insurance Payment
• Allowed Amount
• Coverage percentage

In the bluebook entry, by entering the Allowed Amount first, then the Coverage percentage, SoftDent will automatically calculate the Insurance Payment for the procedure as well as the write-off (if any).

The Allowed Amount can be filled in automatically in the plan's bluebook entries by linking an Allowance Table with matching allowed amounts to the plan. The Coverage percentage can be filled in automatically in the plan's bluebook entries by entering them in the "Coverage" tab of the insurance plan for each code class. For these reasons, it is recommended to configure insurance plan settings in the following order:

1. Select the insurance plan's Estimation Type.
2. Enter the Coverage percentages for each code class under the insurance plan's Coverage tab (don't worry if there are some procedures that are exceptions; the Coverage percentage for individual procedures can be manually changed once the bluebook entries have been created).
3. Under the Coverage tab, in the "Allowance Table" drop-down, select the Allowance Table containing the allowed amounts that should be used for this insurance plan. Note: make sure to select an allowance table with allowed amounts that match the plan's EXACTLY, as allowed amounts cannot be manually changed in the plan's individual bluebook entries while an allowance table is linked. If no such allowance table exists, create a new allowance table with the plan's exact allowed amounts entered.
4. The bluebook entries will be created automatically based on the allowed amounts in the table, the coverage percentages entered under the plan's "Coverage" tab, and the Fee 0 for each procedure.

SoftDent will now be able to estimate the insurance payment, patient portion, and write-off for procedures with bluebook entries.  The insurance plan can also be configured for SoftDent to post its write-offs automatically by checking "Post Write Off at time of service" in the bottom left corner on the insurance plan's window.

Please note: if another allowance table has already been linked to the plan, or if the bluebook contains entries for procedures that do not have allowed amounts entered in the allowance table, a "Yes or No" prompt to delete such bluebook entries will be displayed. Select "Yes" or "No" based on your preference, or if unsure, choose "No" to prevent these bluebook entries from being unintentionally deleted.

Does this answer your question?  If not, please let me know.  

Regards,
Wesley Barron
Technical Support Analyst