Advanced insurance setup question

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Andrea
Posts: 16
Joined: Wed Jan 04, 2017 1:11 am

Advanced insurance setup question

Post by Andrea » Sat Jan 14, 2017 10:13 pm

Hi there,

I'm in New Zealand and I'm wondering how I would set this up.

We don't have insurance like in the USA so insurance terms are very unfamiliar, but there is a government scheme here where if you are injured in an accident a set fee is paid per procedure towards your dental treatment. It is called ACC.

The patient pays my usual fee, minus whatever ACC contributes.

ACC has its own unique procedure/claiming codes. Sometimes several of my fees will map on to one of their codes -for example I might charge different fees depending on how complex an anterior composite is, but ACC may just have one set fee/code to cover all of these. For other treatments it goes the other way -I just have one bundled fee for an implant crown, but ACC has multiple codes I need to claim for this procedure.

(This is not so important, but If the tooth is over a certain percentage damaged for non accident related reasons then ACC reduces this fee by a certain percentage. This happens very rarely and I'm happy to manually change the fee in those few cases.)

I'm running the trial version and trying to set up as much as possible before the practice opens in May. I could upgrade now if needed.

I have been watching the insurance webinars but I'm not sure what the best way to attempt to set this up would be. Help!

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

Re: Advanced insurance setup question

Post by rhaber123 » Sun Jan 15, 2017 2:22 am

You have to create some new procedure codes in OD to match ACC procedure codes. (that is going to be a lot of work)
Login as administrator, Main menu, Lists, Procedure codes, + New
Here you can add your own " CODEs" , and in the description you can write the DESCRIPTIONS that match ACC procedure codes.
(probably it will be better also to create a new category and call it ACC, and put all the new codes in that category)
and if you created YOUR fees for that procedure , you can enter it now.

(ACC could be considered as a fee schedule plan and not a PPO plan)
Last edited by rhaber123 on Sun Jan 15, 2017 9:52 am, edited 3 times in total.

Andrea
Posts: 16
Joined: Wed Jan 04, 2017 1:11 am

Re: Advanced insurance setup question

Post by Andrea » Sun Jan 15, 2017 2:44 am

ok thanks.
I thought ACC should be a co-pay or out of network schedule but wasn't sure which -Have I got that wrong?

I'm hoping I can share the codes at the end somehow with other users here.

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

Re: Advanced insurance setup question

Post by rhaber123 » Sun Jan 15, 2017 2:59 am

You are correct (ACC sould be considered as a copay/fee schedule plan and not a PPO plan)

the above instructions shows how you create the Standard fee schedule, it has YOUR office fees for the ACC procedure codes.

=================================================================================================================

OD allows you to enter a fee schedule for each insurance that you provide service to.
1- Now you need to create a second fee schedule. ACC fee schedule.
http://www.opendental.com/manual/procedurefees.html
http://www.opendental.com/manual/feeschedules.html

2- Remember, when you add that insurance plan to the patient records in the family module be careful under " plan type " to enter the right option, should be under "FLAT COPAY"and not PPO Percentage
3- When you complete a procedure, OD will enter your fees for that procedure, and will enter the fees that ACC will pay, and you can collect the estimated patient portion


=================================================================================================================

when you finish, the codes can be shared, they can be exported. Just Post it here when done, and you will be guided on how to do it. Many will appreciate it .

FORUMS - SHARING
viewforum.php?f=5

Andrea
Posts: 16
Joined: Wed Jan 04, 2017 1:11 am

Re: Advanced insurance setup question

Post by Andrea » Sun Jan 15, 2017 7:18 pm

Thank you so much -I don't think I would have been able to work that out myself. I'll post it when completed and hopefully someone else can benefit too.

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