The standard dental insurance coverage tables are coverage table templates that can be used for dental insurance plans. By default, the first coverage table template is automatically assigned to each new insurance plan, but you can assign a different coverage table template. Furthermore, the assigned coverage table template can be modified for only that insurance plan without affecting the coverage table template that it is based on. Dentrix Enterprise includes five coverage table templates that you can use as-is or customize to meet your practice's insurance needs.
Coverage tables help make your treatment estimates accurate. A coverage table allows you to group several procedures into ranges and specify the percentage that insurance will pay, or you can list each procedure separately. When editing coverage table templates, you must use the ADA procedure codes and cannot overlap the beginning and ending procedure codes in any given range.
Note: Accessing the coverage table templates to edit them requires the "Insurance Coverage, Modify" security right.
To edit a coverage table template
In Office Manager, on the Maintenance menu, point to Reference, and then click Dental Ins Coverage Tables.
If applicable, do one of the following:
If the Password - Insurance Coverage, Modify dialog box appears, user verification has been assigned to the "Insurance Coverage, Modify" task. Do one of the following:
If your user account has been granted the "Insurance Coverage, Modify" security right, enter your credentials in the User ID and Password boxes, and then click OK.
If your user account has not been granted the "Insurance Coverage, Modify" security right, have a user with permission temporarily override this restriction so you can access the coverage table templates this one time. The overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
If a message appears, informing you that you do not have rights to this operation, your user account has not been granted the "Insurance Coverage, Modify" security right. To have a user with permission temporarily override this restriction so you can access the coverage table templates this one time, do the following:
On the message, click Yes.
In the Password - Insurance Coverage, Modify dialog box, the overriding user enters his or her credentials in the User ID and Password boxes and then clicks OK.
The Standard Insurance Coverage Tables dialog box appears.
Select a coverage table template.
Click Edit.
The Insurance Coverage Table dialog box appears.
If necessary, change the name of the coverage table template in the Coverage Table box.
Do any of the following as needed:
To clear the entire coverage table template, click Clear. All procedure codes ranges are deleted, and the name changes to Coverage table not set up. So, you must enter a name, and set up all procedure code ranges.
To delete a procedure code range from the coverage table template, do the following:
Select a procedure code range.
Click Delete.
To change a procedure code range of the coverage table template:
Select a procedure code range.
Change any of the following options for the selected range:
Beg Proc - The beginning procedure code in the range.
Note: If you are assigning only one procedure to a range, enter that procedure code in the Beg Proc box, and leave the End Proc box blank. The End Proc box will automatically be filled in with the beginning procedure code.
End Proc - The ending procedure code in the range.
Note: If you are assigning only one procedure to a range, enter that procedure code in the Beg Proc box, and leave the End Proc box blank. The End Proc box will automatically be filled in with the beginning procedure code.
Category - A name to represent the range of procedure codes, such as an ADA Procedure Code Category name.
Cov % - The percentage the insurance carrier will pay for any of the procedures in the range.
Ded - The deductible type for the range of procedure codes.
Co-Pay - For a capitation plan, the patient's co-pay amount. If the plan is not a capitation plan, enter 0.00 in the box.
Pre Est? - Whether a pre-treatment authorization is required or not. If the insurance company requires you to submit a pre-treatment estimate for a procedure in the range, select this checkbox; otherwise, clear the checkbox.
Note: As you modify the coverage table template, keep the following in mind:
You must use ADA Procedure Codes.
You may not overlap the beginning and ending procedure codes in any given range.
A procedure code can pertain to only one range.
Click Change.
To add a procedure code range to the coverage table template:
Select a procedure code range.
Change any of the following options for the selected range:
Beg Proc - The beginning procedure code in the range.
Note: If you are assigning only one procedure to a range, enter that procedure code in the Beg Proc box, and leave the End Proc box blank. The End Proc box will automatically be filled in with the beginning procedure code.
End Proc - The ending procedure code in the range.
Note: If you are assigning only one procedure to a range, enter that procedure code in the Beg Proc box, and leave the End Proc box blank. The End Proc box will automatically be filled in with the beginning procedure code.
Category - A name to represent the range of procedure codes, such as an ADA Procedure Code Category name.
Cov % - The percentage the insurance carrier will pay for any of the procedures in the range.
Ded - The deductible type for the range of procedure codes.
Co-Pay - For a capitation plan, the patient's co-pay amount. If the plan is not a capitation plan, enter 0.00 in the box.
Pre Est? - Whether a pre-treatment authorization is required or not. If the insurance company requires you to submit a pre-treatment estimate for a procedure in the range, select this checkbox; otherwise, clear the checkbox.
Note: As you modify the plan's coverage table, keep the following in mind:
You must use ADA Procedure Codes.
You may not overlap the beginning and ending procedure codes in any given range.
A procedure code can pertain to only one range.
Click Add.
Click OK.
Click Close.