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admin_bowlerdds
Canine II

INSURANCE

Has any one experienced the process of setting up insurance you are not a provider of but because you are a provider of the Company required to do a W/O.  Example Anthem 100/200- Anthem 300.  Patient has 100/200 we are providers for the 300 therefore do a w/o from 300 allowable  plan pays on 100/200 approved amount. setting up blue book with allowed amount gives you too much of a w/o setting blue book up approved amount gives you incorrect insurance % paid.

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3 Replies
mdunham
Premolar III

Re: INSURANCE

Add the 300 allowance table to her plan.   You can set the plan as a Ppo% or PPO flat fee.     

If you set as PPO flat fee- you will simply add in the payment on the 100 schedule, and SD will then prompt for payment from PT up to the 300 schedule and will calculate adjustment to 300. 

If you set as PPO % , you will need to adjust the percentage until the payment box comes close to actual payment from plan.  The adjustment will be to your 300 schedule and pt copay will be close but not exactly precise. 

In this scenario,  I recommend PPO flat fee option.  

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admin_bowlerdds
Canine II

Re: INSURANCE

Thanks we have already tried both ways and by no means does the co pay come out correctly. Its old school figuring that works every time!

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mdunham
Premolar III

Re: INSURANCE

Well that is frustrating.  I am curious though. Mine comes out perfectly.   Have you tried calling SD support?  Perhaps they can login and assist you? 

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