Where to enter insurance's fee schedule?

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MarynaOvch
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Where to enter insurance's fee schedule?

Post by MarynaOvch » Thu Apr 26, 2012 10:00 am

May be my question was not clear. Trying again.
We are a new practice and need to know where to enter the insurances's fee schedules. In the upper panel there are tabs Log off, file, set up, list, tools. So, I enter the fee schedule going to the
'list' in the upper panel, choosing procedure codes, then ad fee schedule of the new insurance and start with the fees entering.
Is it the right place? Or is it designed for something else, say, discount plans?
Thank you


What is the place for entering max allowable charges of the PPO insurances we participate with. I have been entering them in the procedure codes, but is it the right place?

bpcomp
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Re: Where to enter insurance's fee schedule?

Post by bpcomp » Thu Apr 26, 2012 3:06 pm

There are several options with insurance fees but you can start by looking at http://www.opendental.com/manual/feeschedules.html. I would recommend calling OpenDental support and having them walk you through one over the phone and them remoted in. That is probably the fastest and most reliable way to learn.

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jordansparks
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Re: Where to enter insurance's fee schedule?

Post by jordansparks » Thu Apr 26, 2012 10:28 pm

Yes, you enter your fees in the Procedure Codes window. And you also create a separate fee schedule (normal, not copay or allowed) for entering your allowed PPO fees. See this page:
http://www.opendental.com/manual/insplantypes.html
Jordan Sparks, DMD
http://www.opendental.com

ForrestGumpDDS
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Re: Where to enter insurance's fee schedule?

Post by ForrestGumpDDS » Sun Apr 29, 2012 10:04 am

Thank you bpcomp and Jordan for pointing my wife into right sections of manual. I'm a dentist and know just some stuff about billing, and she does not have any billing experience at all. So we both have a lot of questions that might look rather straightforward ones.
Now, let me mak sure I understood you correct.
For PPO plans that we participate with we suppose to do following:
Set-up -> Fee Schedule then enter a new plan (named Cigna, BSBS or whatever we participate with) and in selection box select select "normal" (which is a default value).
Then go to List -> Procedure codes, find corresponding plan and edit values for procedure codes to those that are in insurance maximum allowable charges by double clicking and editing each cell.

Now, we also participate with plans that are called "discount plan" which is not a real insurance, but they will refer pts which would pay reduced fees themselves for procedures. How do I put those fee schedules in the system so I can still show pt. what my fees are on estimates?

Edit. Also, when do we need to set up "List -> Insurance carriers". I did a test entry there and cannot find this entry being used anywhere in patient's chart. Might be missing it.
Thank you

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Jorgebon
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Re: Where to enter insurance's fee schedule?

Post by Jorgebon » Sun Apr 29, 2012 11:16 am

You enter the fee schedule for the discount plan the same way you enter any other insurance company's fee schedule. You already know how to do that. The next step is when a patient comes for treatment, you will go into the family module and after entering all the patient's demographics, you click on the insurance icon and fill in all the information. You will notice that the information for the insurance company that you enter here will appear in the LISTS/Insurance carriers window you mentioned. This is so that after you enter the information for the first time, Open Dental will fill in all the info for the carrier when you type the carrier's name every time you fill in this info for other patients. This window you are now in is the place where you select the type of plan and what fee schedule applies. If the plan is a category percentage type plan you double click in the percentages box in the right hand side of the window to enter the specifics and percentages for the plan. If the plan is a discount type plan where the patient pays everything as you mentioned, you could specify that the fee schedule that applies is the discount plan's schedule and enter all categories at 0%.
After you master the basics in defining insurance plans, you may want some help with other types of plans that are more complicated or with situations where not everything within a category is covered.
Jorge Bonilla, DMD
Jorge Bonilla DMD
Open Dental user since May 2005

ForrestGumpDDS
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Re: Where to enter insurance's fee schedule?

Post by ForrestGumpDDS » Sun Apr 29, 2012 9:38 pm

Thank you Jorgebon, your explanation makes it clear.
And what would I want to do if some procedures are not covered? I was planning to skip non-covered procedures as I enter plan fees in Procedure Code window for that carrier. That should bring my fees on estimates and show pt's portion as 100% of my fees. Now, what I think may be making it more complicated is that if same carrier might have some procedures covered for one group and non-covered for another group within same plan. But my knowledge on billing are not that advanced, I'm not even sure if this scenario is real.
Thank you.

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Jorgebon
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Re: Where to enter insurance's fee schedule?

Post by Jorgebon » Mon Apr 30, 2012 8:24 am

Let's say a certain plan covers endodontics at 70%, except for endo on molars where it doesn't cover (0%). You enter 70 in the endo box in the "Edit benefits" window, then you go into the "other benefits" box by clicking ADD at the bottom of the box. Select Category - None. Enter D3330 in the "or Proc Code" field. Enter 0 in the "Percent" field. Click OK. Now all endo is at 70% except for D3330 which is at 0%.
Jorge Bonilla, DMD
Jorge Bonilla DMD
Open Dental user since May 2005

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