Delta dental premier HELP

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officemanagerSS
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Delta dental premier HELP

Post by officemanagerSS » Wed Apr 15, 2015 9:21 am

what do I put for the fee schedule in open dental for the delta premier. proposed fee or contracted fee?

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Arna
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Re: Delta dental premier HELP

Post by Arna » Wed Apr 15, 2015 9:45 am

This is slightly more complicated than a traditional PPO Plan.
You will use a Normal Fee schedule for your contracted rates to calculate writeoffs. Open Dental uses the logic Provider Fee - PPO Fee = Writeoff.
If Delta Dental then pays on a reduced Fee Schedule, you will have to use a Copay Fee Schedule. The Copay Fee Schedule will be the difference between Premier and the other fee schedule.
For example:
You charge $100 for a procedure. Your contracted rate with Delta is $75. This plan will pay on a lesser Fee Schedule of $65.
Your PPO Fee Schedule will be $75. This will give you the $25 write off.
Your Copay Fee Schedule will be $10 (the difference between the PPO and lesser fee).
Open Dental will then apply the percentages of coverage to the remaining amount ($65).
Entropy isn't what it used to be...

Arna Meyer

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Jorgebon
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Re: Delta dental premier HELP

Post by Jorgebon » Wed Apr 15, 2015 1:05 pm

Do you have a Delta PPO contract or a Delta Premier contract?
Jorge Bonilla DMD
Open Dental user since May 2005

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savvy
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Re: Delta dental premier HELP

Post by savvy » Thu Apr 23, 2015 2:29 pm

Co-Pay Fee Schedule?
What, pray tell, is that?
Standard Fee $100
Delta Fee $ 75
Delta Pays $ 65
Write Off $25
Pt Pays $10

Please explain why I might need a Co-Pay Fee Schedule for that?
Seems like a simple math problem to me.
Which, by the way, Open Dental figures out all by itself.
What am I missing?
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

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Arna
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Re: Delta dental premier HELP

Post by Arna » Thu Apr 23, 2015 5:00 pm

You can only assign one normal fee schedule to a plan. If you want the writeoff calculation in addition to the reduced insurance fee, there will need to be both the normal fee schedule (for the writeoff) and the copay for the difference.
Entropy isn't what it used to be...

Arna Meyer

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savvy
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Re: Delta dental premier HELP

Post by savvy » Mon Apr 27, 2015 2:36 pm

I guess I don't understand what you mean.
For 11 years I have done the following:

Bill Delta Dental my UCR fee of $X for procedure that my Delta Premier fee being <$X.
It makes no matter whether the group pays 100% or 50%.
When payment is received, OD writes off the difference $X-<$X and either shows the remaining copay if plan pays less than 100% or the zero balance if paid at 100%.
I only have two fee schedules in OD.
My UCR and Delta Premier.

What am I missing?

Cheers!!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

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Jorgebon
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Re: Delta dental premier HELP

Post by Jorgebon » Mon Apr 27, 2015 4:10 pm

The way we set up Delta plans depends on if you are a Premier dentist or a Delta PPO dentist. If you re a Premier dentist like me and the patient has a Delta PPO plan, Delta will pay the PPO fee and you can bill the patient the difference between the Premier fee and the PPO fee. You should have a normal fee schedule to list your Premier contracted fees and an allowed fee schedule to list the PPO fees. When you enter the plan's details you choose Delta Premier as the fee schedule and the allowed Delta PPO as the allowed fee schedule. We use the "Category Percentage" plan type.
If you are a Delta PPO dentist then you have to accept the lower PPO fees and you can set up the plan as a PPO percentage plan. You would need to set up a normal fee schedule for the PPO fees.
Jorge Bonilla DMD
Open Dental user since May 2005

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savvy
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Re: Delta dental premier HELP

Post by savvy » Mon Apr 27, 2015 4:40 pm

You make it too difficult.
When i post a payment for a delta ppo or aarp fee schedule for the first time on a patient with delta, i enter the allowed amount, the payment amount and the write off amount.
The next time the same procedure code comes up, all the fields get automatically filled in.
Easy peesy.
Cheers!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

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Arna
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Re: Delta dental premier HELP

Post by Arna » Mon Apr 27, 2015 4:57 pm

Are you using Allowed or Normal Fees?
Allowed have the ability to learn, but don't give the writeoffs in TP estimates. Normal/Copay gets everything right, but is static.
Entropy isn't what it used to be...

Arna Meyer

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savvy
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Re: Delta dental premier HELP

Post by savvy » Mon Apr 27, 2015 5:46 pm

Again, I'm not sure of your question.
There is a box/column listed as "Allowed", there is no such space that I see called "Normal."
In the "Billed" space, I have my everyday fee, in the "Deductible" space I put whatever is applicable, in the "Allowed" space I place what that Delta Premier Plan allows for the fee, in the "Ins Pay" I put what is paid by Delta, in the "Write-off" space a number automatically appears. That number is the difference between "Billed" and "Allowed". The balance due is Billed minus Write-off minus payment.

Cheers!!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

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