There are two commonly accepted methods for administering a preferred provider (PPO) insurance plan in Dentrix. You can either charge the fees contracted with the insurance company, or you can charge your usual and customary fees and then write off the difference on each account.
Method 1 posts the contracted insurance fee schedule to the Treatment Planner and the Ledger while posting the provider's standard fee to the insurance claim.
To set up a PPO insurance plan
1. Create a new insurance plan.
2. Create a fee schedule for the insurance's allowable fees.
3. Select a claim format.
Note: We recommend that you select a claim format with a name that ends in the letter F, such as DX2007F.
4. Attach the fee schedule to the insurance plan.
5. Set up the insurance plan to use a claim format that displays the provider fee rather than the charged fee in the Ledger.
6. Create a billing type for PPO participants.
Note: Creating a billing type and assigning patients to it may help you isolate these patients from the rest of your practice for generating reports and billing statements. Use no more than five billing types for PPO plans. If you support fewer than six PPO plans, create a billing type for each plan. If you support more than five PPO plans in a given company, group several plans and create a billing type for each group. If you support several PPO carriers, add a billing type for each carrier.
Method 2 posts the provider's full fee to the Treatment Planner and the Ledger, but providers must manually add a write-off adjustment to each transaction.
To set up a PPO insurance plan
1. Create a new insurance plan.
2. Create a billing type for PPO participants.
Note: Creating a billing type and assigning patients to it may help you to isolate these patients from the rest of your practice for generating reports and billing statements. Use no more than five billing types for PPO plans. If you support fewer than six PPO plans, create a billing type for each plan. If you support more than five PPO plans in a given company, group several plans and create a billing type for each group. If you support several PPO carriers, add a billing type for each carrier.
3. Create an adjustment type for the PPO plan.
4. Enter the insurance estimates for the PPO plan in the payment table for all procedure codes.
Note: Consult the insurance carrier to determine the contract fee for each procedure.
5. Assign the PPO billing type to the appropriate patients' accounts.