There are many aspects of an insurance plan’s coverage information to keep track of, including deductible amounts, plan maximums, or the plan’s coverage table information. In Dentrix, you can modify an insurance plan’s coverage information to keep it up-to-date.
Watch the following video to learn how to modify insurance plan coverage information. (Duration 4:13)
Additional Tips
- When the Deductibles/Maximums window is opened through a patient’s Family File (as opposed to the Office Manager), additional columns appear in the tables for the current year and the previous year, which allows you to enter deductibles met and benefits used for that selected patient. When opened through the Office Manager, those patient-specific columns are not available. Therefore, any changes made to the plan through the Office Manager applies to the entire plan and to all patients assigned to that plan.
- The coverage table can also be updated from a patient’s Family File. To do so, double-click the insurance block, click the Benefits/Coverage button, and select the Coverage Table tab.
- When you create a new insurance plan, Dentrix assigns the “#1 Default Insurance Coverage Table” to that plan. You can view or edit the insurance coverage tables by going to Office Manager > Maintenance > Reference > Default Insurance Coverage Tables.
- The Coverage Table’s headings consist of the following fields:
- Beg Proc and End Proc – The beginning and ending codes, respectively, of the procedure code’s range. (You must use 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 ending codes the same.)
- Category – The name of the procedure code range(s). (Dentrix allows you to group several procedures into categories and assign them the percentage that the insurance carrier will pay. You may also have one procedure in a category.)
- Cov% – The percentage that the insurance plan pays for the procedures in that code’s range, after any deductibles. (Dentrix estimates 0% coverage for any procedure codes not listed in the Coverage Table.)
- Deductible – The type of deductible for a procedure code range. (You can assign each range of procedure codes its own deductible type — Standard, Preventative, Other, or None.)
- Co Pay – The portion of the total amount that a patient pays. (Use co-pays only if you’re setting up a “capitation” plan.)
- Pre-Auth – This box should be checked if the insurance carrier requires a pre-authorization for the procedures in that code range.
- When you select a different Standard Coverage Table, the entire table will be replaced with the one you chose. If you’ve made changes to the table, these changes will be lost when selecting a different coverage table.
- The claim deadline information is used on the Procedures Not Attached to Insurance report.
- Changes made to the Coverage Table will affect all patients to which this insurance plan is assigned.
- The options in the Co-Payment Calculation for Ins Portion drop-down menu enables Dentrix to acknowledge the patient’s co-payment dollar amount for each category. However, if the plan you’re modifying is not a capitation-type plan, with specific co-payment amounts for each procedure, do not select this option.
- Use insurance plan notes to document special carrier requirements, frequency limitations, and any other such data. All insurance plan notes appear for any patient with that insurance plan, and they also appear in the Insurance Claim dialog box but do not print on the claim.
- Dentrix provides five standard coverage tables that you can modify to fit your specific insurance plan needs. When you add a new insurance plan, Dentrix automatically assigns the Default Coverage Table to it. To learn more about these tables, read Insurance Coverage Tables in Dentrix Help.
- To learn more about modifying insurance plan coverage information, read Creating Coverage Tables, Editing the Default Coverage Tables, Editing Coverage Table Categories, and Deleting Coverage Tables in Dentrix Help.
Check Your Knowledge
If you have access to Dentrix, check your knowledge with this exercise.
- Switch to the Dentrix demo database.
(Skip this step if you are using the Dentrix Learning Edition software.) - Use the following information to modify the Lincoln National/Qwest insurance plan (or any other plan):
- Standard Individual Annual Required: $75
- Standard Family Annual Required: $200
- Standard Maximum Individual Annual Benefit: $2,500
- Standaard Maximum Family Annual Benefit: $6,000
- Note: “Sealants are not covered after age 14.”
- Periodontics Procedures (X5287 – X6286): 60%
- Confirm your changes and return to the Office Manager.