Fee schedule based PPO.

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ForrestGumpDDS
Posts: 177
Joined: Fri Oct 14, 2011 3:31 pm

Fee schedule based PPO.

Post by ForrestGumpDDS » Tue Dec 12, 2017 4:34 pm

Hi everyone.
Setting up a new insurance. Very similar to the HMO with supplementals as described in manual, except for it's a PPO and has deductible and yearly maximum.
So, the insurance has a maximum allowable charge, but the patient pays the portion based on the separate fee schedule rather than on percentage. The deductible and yearly maximum applies.
Also, I believe there might be downgrades, just to be sure I covered everything.
Just wanted to double check that I am setting it up right.
  • Add a new plan to the patient, set it up as PPO, cathegory procentage, insurance pays 100.
  • Create a copay schedule, set it to the patient copay amounts.
  • Create a normal schedule, set the values to maximum allowable charge
  • Check "show UCR"
  • Uncheck "Do not downgrade", set the deductible etc
When I am doing so, I see on the claim that the my office fee and insurance fee for the procedure are in reverse.
For example. My office fee for D2954=265, ins. MAC=207, patient copay=96, deductible =50.
So, I create and complete the procedure D2954 (AFTER setting the insurance as per above steps AND clicking "update fees" in the TP module).
This shows me D2954 with the balance of 207 in the account module. Creating the claim, and see ther as follows: Fee=207, Ins. fee=265, deductible=50, Ins estimate 61, Ins pays=0, write off=0.
The account module shows the appropriate patient balance of $146 (96 copay+50 deductible)

Where did I get it messed up?

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cmcgehee
Posts: 711
Joined: Tue Aug 25, 2015 5:06 pm
Location: Salem, Oregon

Re: Fee schedule based PPO.

Post by cmcgehee » Tue Dec 12, 2017 5:05 pm

This situation sounds like it's going to be too tricky to figure out over the forums. Call in to our support and we'll help you figure it out. If you aren't able to get an answer, escalate to me and I'll jump on the call.
Chris McGehee
Open Dental Software
http://www.opendental.com

ForrestGumpDDS
Posts: 177
Joined: Fri Oct 14, 2011 3:31 pm

Re: Fee schedule based PPO.

Post by ForrestGumpDDS » Tue Dec 12, 2017 5:14 pm

Gerat, will do tomorrow.

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