Treatment plan percentages

sonria · Post by **sonria** » Sat Feb 16, 2008 8:53 pm

When it is calculating PPO percentage estimates, the "carrier allowed amount" is lower than the fee schedule already entered in the fee schedule listing. For example, if the fee is $209 for for a two surface composite, the "carrier allowed amount" shows $164 and then calculates the pt co-pay accordingly.
Can someone tell me if they have had a similiar issue or how to fix it?
Thanks

Post by **jordansparks** » Sat Feb 16, 2008 10:26 pm

What specific version are you using? Also, it sounds like it's behaving perfectly. The $209 would be your standard fee, and the $164 would be what you contracted with the PPO to charge. So it should be basing the percentage off the $164, right?

Actually, you might be experiencing a totally separate feature, which is the reduction of posterior composites to the amalgam fee. In the manual, this is referred to as a substitution code. This is a typical insurance situation. In version 5.6 (not yet released), you can turn off this feature for specific insurance plans. In your version, you could disable it for all insurance plans by going to the procedurecode edit window.

sonria · Post by **sonria** » Sun Feb 17, 2008 10:51 am

Thanks for your response Jordan. Yes, you are right! It is very clear to me now. It is billing as amalgam for posterior
I am using 5.5 version. Here is another example:

Thank you for this worderful software.