Editing coverage tables

You can easily edit insurance coverage tables and deductible information by completing the following steps. You can use coverage tables to group several procedures into categories and assign the percentage the insurance will pay. You may also have one procedure in a category.

To edit a coverage table

1.   In the Patient Banner, click the Settings button.

The Settings dialog box appears.

2.   Click Maintenance, and then click Insurance Maintenance.

The Insurance Maintenance dialog box appears.

3.   Select the carrier whose coverage table you want to edit, and then click Cov Table.

The Insurance Coverage dialog box appears.

4.   Under Deductible, edit the appropriate deductible amounts:

·        Standard - The deductible that applies to most procedures.

·        Preventive - The deductible if an insurance carrier’s coverage has a separate deductible for preventive/diagnostic procedures.

·        Other - The deductible if an insurance carrier’s coverage has a separate deductible for specific procedures other than preventive/diagnostic or for procedures not considered standard.

·        Lifetime - The deductible that requires subscribers to pay one deductible for the life of the policy.

·        Annual Individual - The deductible that requires patients to pay a deductible amount each year.

·        Annual Family - The deductible that requires a maximum deductible amount for the entire family each year.

Note: You can assign a deductible type to each range of procedure codes in a coverage table. You can also assign a lifetime, individual, and family deductible to each deductible type. Easy Dental calculates the patient portion of charges and adds the appropriate deductible to the patient's payment due.

5.   Edit the Annual Maximum Benefit amounts for Individual and Family.

6.   Click the Claim Deadline search button.

The Deadline dialog box appears.

7.   Select the amount of time allowed by the insurance carrier before pre-treatment estimates or claims expire and will not be accepted, and then click OK.

8.   To change the coverage table, click the Select Table search button.

The Select Coverage Table dialog box appears.

Note: Easy Dental provides five standard coverage tables that you can modify to fit individual insurance plans. When you add a new insurance plan, Easy Dental assigns the first standard coverage table to it automatically.

9.   Select the table most similar to the coverage of the selected insurance plan and click OK.

The plan is copied. As necessary, you can modify the plan.

Note: If you do not have or know the insurance carrier's schedule of benefits, the first standard insurance table is assigned to the plan. As you receive payments and make estimates, Easy Dental gives you the option to update an insurance plan's payment table automatically. The dollar amount that each insurance carrier pays by procedure is stored. Insurance estimates are then based on past payments, making your estimates very accurate.

10. As necessary, change the following options, and then click Change:

·        Beg Proc - Type the beginning code of the procedure code range.

·        End Proc – Type the end code of the procedure code range.

Note: You must use the ADA procedure codes, and you cannot overlap the beginning or ending procedure codes in any range. To assign a single code to a category, make the beginning and end codes the same.

·        Category – Type a name for the procedure code range.

·        Cov% – Type the percentage that the insurance plan pays for the procedures in the code range after any deductibles.

Note: Easy Dental estimates 0% coverage for any procedure codes not listed in the coverage table.

·        Deductible – Select a type for the procedure code range.

·        Co Pay – Type the amount the patient pays only if you are editing a capitation plan.

·        Pre-Est – Select if the insurance carrier requires a pre-estimate for the procedures in the code range.

11. If the plan is a capitation plan, under Co-Payment Calculations for Ins. Portion, change the way the amount the insurance carrier will pay is calculated.

12. To edit a note documenting an insurance carrier's special requirements or other information, click Notes.

The Insurance Plan Note dialog box appears.

a.   Type the note.

b.   To insert a date, click Insert Dateline.

c.   To perform a spell check, click the spell check button.

d.   Click OK.

Note: You can update insurance plan notes at any time. Insurance plan notes do not print on claims.

13. To change the coverage table, click OK.

A message appears.

14. Click OK to implement the changes you made for all patients assigned to the selected plan.