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Attach Insurance Maximums, Age and Frequency Limitations to Coverage Table Categories or Individual Procedures.

Need to be able to attach insurance maximums/limitations to individual procedure codes and/or categories (could be done with coverage tables). Both monetary maximums and a maximum number of times the code will be covered each year, as in the case of prophies, bitewings, etc. Also age limtes. Should tie into the Continuing Care system so a warning message comes up if an appointment is scheduled before insurance will pay for it, and a patient will be flagged when their insurance will once more pay for a procedure. Also needed in the case of crowns and other procedures that will not be covered within five years of the initial placement. Would also like to setup separate lifetime and annual maximums for certain categories, such as orthodontic and perio work, and flag any procedures or categories that should not be counted against any maximum. Display these limitation in the Treatment Planner and on the Route Slip. Need to be able to specify which services the Maximum applies to. [4068]

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234 comments

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  • Betty commented  ·   ·  Flag as inappropriate

    Only thing I would add is if it could tell if frequencies were 'separate' or 'in addition to'. Examples: 2 prophylaxis and 2 perio maintenances (PMT) or only 2 total procedures total.
    Or are panoramic xrays in addition to FMX or are they separate frequencies?

  • Jenna commented  ·   ·  Flag as inappropriate

    age frequencies are also very important for some procedures too, I currently use the notes in the dentrix payment table but than need to check that manually and determine patient portion using this.

  • Brenda commented  ·   ·  Flag as inappropriate

    Any idea how long this will be in development for. Also will this have max for separate procedure groups????

  • Kathy commented  ·   ·  Flag as inappropriate

    something I have wanted for years.

    ps I would also suggest that in addition there be a "notes" field attached to each procedure code for each 3rd party plan as there are sometimes some very creative bs limitations it would be impossible to keep track of other wise. Thank you!!

  • Anonymous commented  ·   ·  Flag as inappropriate

    It would be nice if we could tag a certain patient due to age limitation especially for Flouride. we have many families whenre it is covered for some but not the others

  • Anonymous commented  ·   ·  Flag as inappropriate

    Yes please! Definitely need to be able to customize the coverage better and frequencies would be awesome too!

  • Anonymous commented  ·   ·  Flag as inappropriate

    This is suppose to be top of the line program! We need to separate Ortho Max from General Max. Please do it as soon as possible.

  • Anonymous commented  ·   ·  Flag as inappropriate

    Yeah! We need to add individual procedure's coverage. Some insurance pay @ 80% for single crown/ comp @ 70% its better if we have different way to add insurance coverage. Also,if we can separate max for ortho and regular max.

  • Anonymous commented  ·   ·  Flag as inappropriate

    Any waiting periods for procedures and effective date of insurance coverage is a must.

  • Katie commented  ·   ·  Flag as inappropriate

    This would be so fantastic. Right now we keep notes in the pt file and this would be a fantastic function!

  • Karen commented  ·   ·  Flag as inappropriate

    ALSO, work harder at keeping up with the new insurance contracts. Some now have unlimited benefits for diagnostic and/or preventive services which can have a huge impact on a patient's maximum

  • Anonymous commented  ·   ·  Flag as inappropriate

    THIS WOULD BE EXCELLENT!!! IT IS SO DIFFICULT TO READ EVERYTHING IN THE NOTE SECTION, BECAUSE IT'S ALL BUNDLED UP.

  • Paula commented  ·   ·  Flag as inappropriate

    YES! I would use all of my votes for this, daily, if this website would let me.

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