Why aren't my preauth fees reflecting estimated coverage?

[dwnelson]

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!

[Jorgebon]

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

[dwnelson]

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

[Jorgebon]

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

[dwnelson]

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

[Jorgebon]

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

[Dwayne]

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.