Why aren't my preauth fees reflecting estimated coverage?
Why aren't my preauth fees reflecting estimated coverage?
I am submitting a preauthorization for a connective tissue graft (4273) and in spite of correctly adding the percentage coverage in the insurance section of the Family Module, the estimated insurance coverage (80%) ends up being printed as 0%, or submitted electronically as 0%. This doesn't help!
Re: Why aren't my preauth fees reflecting estimated coverage
Check what fee schedule you have chosen in the insurance definition in the Family Module. Then go to that fee schedule in Lists/Procedure Codes and check if that procedure has a fee listed.
Jorge Bonilla, DMD
Jorge Bonilla, DMD
Jorge Bonilla DMD
Open Dental user since May 2005
Open Dental user since May 2005
Re: Why aren't my preauth fees reflecting estimated coverage
I did what you suggested, the fee schedule is set up properly and has fees for that code, and it didn't help.
Re: Why aren't my preauth fees reflecting estimated coverage
I guess you'll have to call support so they can figure out what's wrong. I can tell you it's working fine for us, so it must be something that's not set up right.
Jorge Bonilla, DMD
Jorge Bonilla, DMD
Jorge Bonilla DMD
Open Dental user since May 2005
Open Dental user since May 2005
Re: Why aren't my preauth fees reflecting estimated coverage
I called support, and the Open Dental software provides no estimates of coverage because it's a preauthorization.
Re: Why aren't my preauth fees reflecting estimated coverage
The way it works for me is that I tx plan a procedure that needs preauthorization, it will show the amount that insurance and patient should pay in the Tx Plan module. I then click on preauthorization to print the form and send it to the insurance company. When I get the response from the ins co, I double click the preauthorization to edit any quantities that may be wrong. I don't understand why they would tell you that this feature is not available.
Jorge Bonilla, DMD
Jorge Bonilla, DMD
Jorge Bonilla DMD
Open Dental user since May 2005
Open Dental user since May 2005
Re: Why aren't my preauth fees reflecting estimated coverage
Most likely, the procedure code that you are using is not in a benefit category, so Open Dental cannot properly calculate the estimate. Please go to Setup > Insurance Categories, and check to see if D4273 is with a span of coverage that is listed. If not, you can add it, or call in to support for assistance. I apologize that you were given inaccurate information when calling in.