Insurance Alternate Codes

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SmilesForSiouxland
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Joined: Fri Aug 28, 2015 1:17 pm

Insurance Alternate Codes

Post by SmilesForSiouxland » Fri Aug 28, 2015 1:21 pm

Hello! New to the forums here, but a quick search didn't show any results.

I've been noticing some instances where insurance companies will combine codes and substitute a different one for things - specifically sets of x-rays. Is there a good way to change these without going all the way back, deleting the claim, adjusting all the codes, etc? We've just been adjusting it through the write-offs, but that's not exactly straightforward. Thanks!

Ryan

Zacky
Posts: 18
Joined: Sat Apr 30, 2016 1:57 am

Re: Insurance Alternate Codes

Post by Zacky » Fri Feb 03, 2017 11:37 am

We have this same problem. A call to support said to just divide the payment out across the non-covered codes...but this doesnt seem like a good idea because it will mess up reporting.

Anyone else have any solutions? Is this a good feature to request?

Scenario: PPO Insurance plans..
- Claim sent in for a Pano (D0330) and 1 PA (D0220) - insurance claim comes back paying $0 for those two codes and applying an alternate benefit of an FMX (D0210) and pays on that code.
- Problem: When entering the payment by procedure there is no where to add the alternate code/benefit that the PPO insurance paid on.

Ideas? If you average out the insurance payment to the unpaid codes you will mess up the reporting when you later try to run a report, for example, on how much you got paid on all Panos if the panos are commonly substituted into another alternate code.

rhaber123
Posts: 415
Joined: Fri Dec 11, 2009 12:09 pm

Re: Insurance Alternate Codes

Post by rhaber123 » Mon Feb 06, 2017 9:10 pm

Your office took a Pano and a single film, these codes should stay in the chart and the ledger, because these are the services that were provided to the patient and billed to the insurance.

Now that the insurance changed it to FMX, OD allows you to enter a "Supplemental" payment to a procedure that was performed.
This will allow you to have the FMX procedure added to the claim, and payment will be posted toward the FMX.

1- When you enter your payment by procedure, pay the Pano and the PA, under " Ins Pay" $0, and click OK
the insurance claim status will change to "Received".
2- now, in the same screen, Pick one of the procedures to highlight it only , for example Pano, it will be highlighted in gray,
and click on " Supplemental", a new window will open (enter payment)
3- click on the procedure (Pano), another window will open (edit claim procedure)
4- under " Code Sent to Ins" enter the code for FMX
5-enter the amount paid by the insurance
6- enter the correct write off if needed
7- under "Remarks from EOB" enter your notes, Insurance Alternate Benefit
and click OK.
8- now you have the FMX procedure added to the claim, and payment is posted toward the FMX
9- "Finalize the Payment", and enter your check information

NOTE: you can modify the postings and the amounts as you desire.
I hope this will help.
Last edited by rhaber123 on Sun Feb 26, 2017 6:34 am, edited 1 time in total.

Zacky
Posts: 18
Joined: Sat Apr 30, 2016 1:57 am

Re: Insurance Alternate Codes

Post by Zacky » Sat Feb 25, 2017 1:14 pm

This is super helpful - thank you Dr Haber! OD customer support wasn't able to provide a solution (they suggested averaging out the fee across substituted codes etc).

I am playing with the supplemental payment feature to account for payments to alternative codes as instructed. Seems to be working okay.

Perhaps unrelated, but cant seem to figure out an answer online in the manual. Once you have entered a claim payment (by procedure), not have not Finalized Payment, is there any way to go back into that Enter Payment (by procedure) Window? It restricts me by saying that, "Procedures that are already received cannot be included."

rhaber123
Posts: 415
Joined: Fri Dec 11, 2009 12:09 pm

Re: Insurance Alternate Codes

Post by rhaber123 » Sat Feb 25, 2017 3:19 pm

lets say you made an error posting the ins payment and you want to fix it.
(do not click on any of the buttons in the upper right corner)

If the payment is not finalized, simple, just double click on the procedure that you want to modify its payment amount
a new window will open," Edit Claim Procedure", here you can modify the ins payments or write off, or etc.....

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Tralston
Posts: 9
Joined: Tue Nov 26, 2013 1:11 pm
Location: Salem, OR
Contact:

Re: Insurance Alternate Codes

Post by Tralston » Tue Feb 28, 2017 9:32 am

rhaber123 wrote:Your office took a Pano and a single film, these codes should stay in the chart and the ledger, because these are the services that were provided to the patient and billed to the insurance.

Now that the insurance changed it to FMX, OD allows you to enter a "Supplemental" payment to a procedure that was performed.
This will allow you to have the FMX procedure added to the claim, and payment will be posted toward the FMX.

1- When you enter your payment by procedure, pay the Pano and the PA, under " Ins Pay" $0, and click OK
the insurance claim status will change to "Received".
2- now, in the same screen, Pick one of the procedures to highlight it only , for example Pano, it will be highlighted in gray,
and click on " Supplemental", a new window will open (enter payment)
3- click on the procedure (Pano), another window will open (edit claim procedure)
4- under " Code Sent to Ins" enter the code for FMX
5-enter the amount paid by the insurance
6- enter the correct write off if needed
7- under "Remarks from EOB" enter your notes, Insurance Alternate Benefit
and click OK.
8- now you have the FMX procedure added to the claim, and payment is posted toward the FMX
9- "Finalize the Payment", and enter your check information

NOTE: you can modify the postings and the amounts as you desire.
I hope this will help.
The one thing I would be leary about is if the supplemental payment you are posting is for a higher amount than the original procedure code you billed to INS, that payment will show up on your Insurance Overpaid report.

As an example:

D0330 billed to insurance with an estimate of $100.00
D0274 billed to insurance with an estimate of $40.00

Alternate benefit applied
D0210 paid at $130.00

If you follow the above steps and do the supplemental for just the D0330 that procedure will show up on the Insurance overpaid report because it is tied to the same ClaimProc. You will still need to "average" out the payment across the 2 procedures for accurate reporting.
Timothy Ralston
Open Dental Software
http://www.opendental.com

Zacky
Posts: 18
Joined: Sat Apr 30, 2016 1:57 am

Re: Insurance Alternate Codes

Post by Zacky » Mon Mar 27, 2017 10:16 pm

Still trying to figure out how to do this cleanly - kinda surprised this isnt a more commonly discussed issue (I imagine every ppo provider experiences this)?!

Dr. Haber, your system works in the sense that its cleaner (it appears) to add a supplemental payment and input that it is for an alternate code (like an FMX instead of pano or bwxs). The problem that Timothy is alluding to is also something we are experiencing. For example...

If I input a supplemental payment for just the 4 bitewing code, because insurance paid for and fmx instead of the 4 bitewings+pano, then I will ultimately show a negative balance on just this 4bwx code since the fmx actually pays higher than the 4 bwx code alone...

..now if I do what Timothy suggests and highlight BOTH the pano and 4bwx code, and then select supplemental payment, then I have to somehow average out the insurance payment over the two codes. While this is a possible way of doing it, I think it is more accurate in the sense that the total money received appears accurate, but it is VERY inaccurate in that (it seems?) because now your reports will show that you are being reimbursed for the pano and 4bwx at an ultra low fee (since you have averaged the payment for an fmx over two other codes, the bwx and pano).

This is not to mention the complicated task for my staff to sit there and guess some arbitrary average payment to assign to the pano and the 4bwx. The ambiguity makes it hard for my staff to know what to do...gah...thoughts??

Am i making this harder than it needs to be? grief. Any videos on this?

rhaber123
Posts: 415
Joined: Fri Dec 11, 2009 12:09 pm

Re: Insurance Alternate Codes

Post by rhaber123 » Mon Mar 27, 2017 10:45 pm

I think these are the only 2 options available now.
A feature request will be required, an additional programing might solve this, it means , when posting a payment, an option will be available to ad an alternate benefit code by checking/highlighting the procedures that the insurance decided to change the code from.

Zacky
Posts: 18
Joined: Sat Apr 30, 2016 1:57 am

Re: Insurance Alternate Codes

Post by Zacky » Wed Mar 29, 2017 11:08 pm

Thank you Dr. Haber for your response as always.

I tried searching for the feature for request but still trying to figure out how that system works exactly...

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Tralston
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Joined: Tue Nov 26, 2013 1:11 pm
Location: Salem, OR
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Re: Insurance Alternate Codes

Post by Tralston » Tue Apr 04, 2017 7:04 am

Zacky wrote:Thank you Dr. Haber for your response as always.

I tried searching for the feature for request but still trying to figure out how that system works exactly...
To Keep it straightforward, inside of the Open Dental program, you can click on Help>Request Features - This will bring up the feature request window where you can search by keyword for a feature you may be looking for. If you find it, you can double click on it and view information regarding the request. If you feel it matches what you want, you can add a vote to it in the upper right hand side. If it doesn't match your request, on the main feature request window, you can click add and enter information regarding your request.

More detailed information can be found here: http://www.opendental.com/manual/featurerequests.html

If you still need assistance with the Feature Request system, feel free to give us a call and one of our technicians can assist you with the process.
(503)363-5432
Timothy Ralston
Open Dental Software
http://www.opendental.com

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