AnsweredAssumed Answered

Which Estimation Type should I choose?

Question asked by loretta_smith on Mar 24, 2017
Latest reply on Mar 27, 2017 by wesley.barron

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.

  • Flat Fee
  • Percentage
  • DMO/Capitation
  • %PPO
  • Flat Fee PPO

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.




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