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Canine II

Full Fees and PPO Fees on Claim forms

I would like to utilize our insurance fee schedules to cut down on adjustments being taken at time of payment posting.  However,  the full fee should be on the claim submitted vs. the ppo fee.  It it my understanding that insurance companies still like to see the office's full fee.  This lets them know of the going rates in the area if they are considering updating their fee schedules.  Also, there are instances where the patient  may not have a procedure as a covered benefit and under their plan they are responsible for the full fee.  If the claim doesn't show the full fee the claim isn't processed correctly.   Until this can be corrected I am only able to use our office fee schedule.   I know this is something that can be accomplished because I have seen it done on other software systems.  Please include this in an update.

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Not applicable

Re: Full Fees and PPO Fees on Claim forms

WinOMS can do what you want.

You can attach your Standard Fee Schedule to the patient on the Demographic Billing Tab.

You can set up must create an Allowable Fee Schedule in addition to your regular fee schedule.

Create a Patient PPO Write-off Adjustment.  

WinOMS will write-off the difference between your office fee and the contracted fee on the ledger at the time of checkout.   There are a couple of caveats however.  1.  WinOMS will show a write-off for each procedure individually.   2.  Because it uses a Patient INS Adjustment your insurance write-offs will not be accurate on your reports that reflect insurance adjustments.

Configure the Insurance Plan Fee/Benefits tab as follows:

Ins Fees/Benefits TabIns Fees/Benefits Tab

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Premolar II

Re: Full Fees and PPO Fees on Claim forms

Can this be corrected in an update to allow us to use (for the Auto W/D Code) insurance-source adjustment codes as well as patient-source adjustment codes?

After all, we are applying the info in the insurance plan's settings, not the individual patient settings; it makes no sense that it would default to exclusively patient-source adjustment codes (and therefore reflect incorrectly on our reports).

Also, when we do the auto-adjustment, is the full fee still billed to insurance on the claim, as the other practice requested above? We want to ensure we are reporting our full fees.

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