Editing plan benefits and coverages

You can use the Dental Insurance Benefits and Coverage dialog box to store and display Electronic Data Interchange (EDI) 271 Eligibility Responses and other coverage information.

Note: Updating any benefit and coverage information will affect all patients who subscribe to the selected group plan.

To edit plan benefits and coverages

1.   With a patient selected in the Family File, double-click the patient’s Insurance Information block.

The Insurance Information dialog box appears.

2.   Click Benefits/Coverage.

The Dental Insurance Benefits and Coverage dialog box for the selected patient appears. The carrier and group plan names appear in the title bar.

3.   Edit the following information as necessary:

·        Benefit Begin Date (Subscriber) – The date benefits began for the subscriber. The default is the current date. To change the date, click the Down arrow, and then select the correct date from the calendar.

·        Benefit Begin Date (Patient) – The date benefits began for the patient. The default is the current date. To change the date, click the Down arrow, and then select the correct date from the calendar.

·        Carrier Contacted On – The date the carrier was most recently contacted. The date updates automatically any time you make a change to the carrier information in the Dental Insurance Plan Information dialog box. You can also change the date by clicking the Down arrow and selecting a date from the calendar.

·        By Prov/Staff ID – Click the Down arrow, and then from the list, select the Provider/Staff ID of the person from your office who most recently contacted the insurance carrier.

·        Insurance Representative – Type the name of the insurance carrier's representative the provider or staff member spoke to most recently.

·        Eligibility Coverage Level – Click the Down arrow, and then from the list, select the appropriate coverage for the selected group plan.

·        Benefit Renewal – Click the Down arrow, and then from the list, select the month when the plan's benefits renew.

·        Insurance Plan Type – Click the Down arrow, and then from the list, select the appropriate plan type:

·        Traditional/Indemnity – Claim payment is based on the procedures performed, usually as a percentage of the charges. Can be paired with a PPO.

·        PPO – A regular indemnity insurance plan combined with a network of dentists under contract to deliver specified services for set fees.

·        HMO/DMO – A contracted dentist is "pre-paid" a certain amount each month for each patient assigned to that dentist.

·        Capitation – A contracted dentist must provide certain contracted services at no-cost or reduced cost to specified patients.

·        Fee Schedule – A type of indemnity plan that pays a set amount for each procedure regardless of the actual charges. Patients are responsible for the difference between the carrier's payment and the charged fee. May be paired with a PPO that limits contracted dentists to a maximum allowable charge.

·        Other – These types of plans could include Exclusive Provider Organizations (EPO), point of service plans, direct reimbursement plans, and so on.

·        Claim Deadline – Click the Down arrow, and then from the list, select a number (1-12). Click the Down arrow in the adjacent box, and then from the list, select Years, Months, Weeks, or Days.

·        Waiting Period – Type the appropriate number of months.

·        Dependent Max Age – Type the maximum age that coverage applies to a dependent.

·        Missing Tooth Clause – Click the Down arrow, and then from the list, select Yes or No.

·        Crowns/Bridges Paid On – Click the Down arrow, and then from the list, select Seat Date or Prep Date.

4.   Click Save.