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sdansby24
Canine II

Fee schedule or bluebook?

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Are we supposed to be using the fee schedule associated with the insurance company, the allowance table, or bluebook or all 3?

Thank you!

3 Replies
Moderator
Moderator

Re: Fee schedule or bluebook?

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hey susan 
the only thing that matters to decide which to use is the estimation type ( ie %PPO , flat fee , medicaid , DMO ..... )
for example for PPO or in network companies you would used allowance table and bluebook 
for medicaid you would use fee schedule 
and so on 
i found this document has some good information about estimation types and bluebook entries 
 

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CS Dental Employee
CS Dental Employee

Re: Fee schedule or bluebook?

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Hello Susan,

The Allowance tables, if your are participating, once the allowance table is created and tweaked, you will need to update the plan information including, Max, Deductible, and %Covered .  once this is updated, you will link the allowance table to the  plan, this creates the Bluebook for you 

You will no longer need to update the bluebook after posting an insurance payment for these plans.

TIP: when adding the allowance tables, delete codes that are made up, and delete downgraded procedures from the allowance tables 

these codes will need manually added to the bluebook after you link the allowance table 

Wendy

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mdunham
Premolar III

Re: Fee schedule or bluebook?

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Wendy, we currently have very accurate bluebooks and tx plans.  The only additional comment I have to your reply above to Susan is the following. 

If you have a downgrade procedure, for instance, Posterior Composites.  Simply create a code, in this instance, I will use 2391 as an example.   2391-Molar 1 Surface Posterior Composite, 2391.2- Premolar 1 surface Posterior Composite.   

Place these code 2391.1 into your allowance table with the same allowance as your 2391.     

Attach the Fee Schedule to the Plan,  after attachment, you will see an allowance for 2391.1  to reflect the downgrade, continue to change the percentage until the payment is near to the actual payment that will be paid by the plan.    You will not want to change the Payment !!!!!!   as it will also change your allowance if the allowance is incorrect, so will your adjustments!   

It's not always precise, but its a lot closer than what you have now.    

If you create these locator codes for procedure codes that routinely downgraded, your treatment plans will almost be perfect.   

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