Why aren't my preauth fees reflecting estimated coverage?

For users or potential users.
Post Reply
dwnelson
Posts: 21
Joined: Mon Sep 26, 2011 5:28 am

Why aren't my preauth fees reflecting estimated coverage?

Post by dwnelson » Fri Nov 16, 2012 10:56 am

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!

User avatar
Jorgebon
Posts: 502
Joined: Mon Jun 18, 2007 2:25 pm
Location: Mayaguez, PR
Contact:

Re: Why aren't my preauth fees reflecting estimated coverage

Post by Jorgebon » Fri Nov 16, 2012 11:23 am

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
Open Dental user since May 2005

dwnelson
Posts: 21
Joined: Mon Sep 26, 2011 5:28 am

Re: Why aren't my preauth fees reflecting estimated coverage

Post by dwnelson » Fri Nov 16, 2012 11:31 pm

I did what you suggested, the fee schedule is set up properly and has fees for that code, and it didn't help.

User avatar
Jorgebon
Posts: 502
Joined: Mon Jun 18, 2007 2:25 pm
Location: Mayaguez, PR
Contact:

Re: Why aren't my preauth fees reflecting estimated coverage

Post by Jorgebon » Sun Nov 18, 2012 4:13 am

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
Open Dental user since May 2005

dwnelson
Posts: 21
Joined: Mon Sep 26, 2011 5:28 am

Re: Why aren't my preauth fees reflecting estimated coverage

Post by dwnelson » Sun Nov 18, 2012 7:15 am

I called support, and the Open Dental software provides no estimates of coverage because it's a preauthorization.

User avatar
Jorgebon
Posts: 502
Joined: Mon Jun 18, 2007 2:25 pm
Location: Mayaguez, PR
Contact:

Re: Why aren't my preauth fees reflecting estimated coverage

Post by Jorgebon » Sun Nov 18, 2012 11:20 am

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
Open Dental user since May 2005

Dwayne
Posts: 59
Joined: Fri Jul 13, 2012 10:46 am
Location: Salem, OR
Contact:

Re: Why aren't my preauth fees reflecting estimated coverage

Post by Dwayne » Wed Mar 27, 2013 4:25 pm

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.
Dwayne
Open Dental Software
503 363 5432
service@opendental.com

Post Reply