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.
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.
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:
For the plan you described:
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:
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:
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.
Technical Support Analyst