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orlyphillips
Canine II

Are we flagging our blue book wrong when a missing tooth clause will be applied?

In the blue book, when we go to the limitations and mark which teeth can be allowed for replacement with a fixed partial denture (bridge) or implant, we find that the insurance still breaks down quoting coverage on teeth that we know will have a missing tooth clause applied.  Are we doing something wrong, or is anyone else having this issue?

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8 Replies
shanab
Premolar I

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

Hello!

Make sure that you are also adding the effective date on the insurance tab from the patient screen.  The software needs a starting point in order to calculate the waiting period.  I hope this is your solution.  Please let us know because development may need to research further if this doesn't resolve it. softdentgirljeffrey.urkevich

Any other thoughts on this one?

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FormerPLM
Premolar III

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

Hi Shana and Orly,

This sounds like the right answer to me.  Orly, please respond to this thread if Shana's suggestion does not resolve the problem.  Thanks for participating in the Community!

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orlyphillips
Canine II

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

We are putting in an effective date.  It still did not break down correctly.  I think that our problem may be due to the fact that we replacing teeth that were previously extracted by other offices, Softdent isn't "seeing" a corresponding extraction date and doesn't recognize that the tooth is missing regardless of the effective date on the policy.  Could that be the issue?

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shanab
Premolar I

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

It could be.  Let me test a couple of scenarios in my test data and see if I can replicate your concern.  Hang tight!

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shanab
Premolar I

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

Are you marking missing teeth in the patient chart or are those teeth still showing as present?  If you are marking work done elsewhere (extractions, endo, etc), make sure you are in "current chart" (white chart) "outside work" (house with arrow pointing out).  If you use the extraction icon , this will make sure you don't generate a bill for the patient. 

If you use the missing tooth icon under the Conditions Toolbar , you can be in either inside or outside work. 

If you aren't marking the teeth as missing, then SoftDent doesn't know it's missing, like you said.  

Let me know if you are doing this process for outside work and then I can set up my tests accordingly.  

Also, what version of SD are you on, Orly?

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orlyphillips
Canine II

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

We are on version 16.2.  The teeth are marked as missing prior to entering the treatment in.  The effective date is entered in. Even still, we are still getting quoted coverage on teeth that are marked as missing.  In the blue book, we can mark under the limitations tab which teeth that procedure can be performed on, but that will limit it to everyone who is on that specific insurance plan.  Can you please tell me, step-by-step, how to enter in an insurance breakdown so that a missing tooth clause is reflected correctly?  I feel like I must be skipping something or doing something wrong.

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CS Dental Employee
CS Dental Employee

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

Currently there is not a specific place to track a missing tooth clause in the software, other than the note section (which is not helpful for estimating).  I would simply mark the transaction as not insurable.  if you want to use the PPO amount for the estimation, you can override the fee. 

The limitation tab under the bluebook will not do anything for a missing tooth clause.

it is designed to give you the ability to select teeth that are covered for a particular code. 

Wendy

mdunham
Premolar III

Re: Are we flagging our blue book wrong when a missing tooth clause will be applied?

f you add those teeth within the bluebook, it will calculate for those teeth on ALL patients attached to that plan.  I would not advise adding "missing tooth clause" to that plan.   

 

Instances you could use those teeth allowance boxes would be, maybe sealants, etc.   

 

I would not advise placing those on something with such a high variable could effect your tx plans for other patients.

There is not a way to do the calculation that you are wanting to do.   Place a team talk on the plan or place it in the notes section of the plan.   Sorry, but I hope this was helpful.