Insurance maximums, limits for coverage table categories
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]
AdminMy Voice Administrator
(Admin, DENTRIX)
shared this idea
Thank you for the feedback, it is much appreciated.
42 comments
-
heathermadeline
commented
This is the most desired enhancement request for our office. We have 6+ providers and a full time staff member who calls on insurance. We are constantly having to hand calculate Invisalign cases and accounts for patient's that have ins. for which preventive services do not accrue toward their maximum. The current Insurance/Ledger setup is so inefficient I can't believe they haven't solved this problem. It isn't even "under review" according to the status.
-
kmbdmd
commented
This should be tied into the treatment plan so that we know before a procedure is scheduled; also, if a tooth was restored in any way within the past 2 years, a note should pop up when any new restorative treatment is planned.
-
Jenna
commented
This would be so helpful. There are countless insurance companies that do no pay a percentage of preventative/basic/major, but rather a certain dollar amount. It would be helpful to alternate the coverage table to adjust their patient portion based off a fee schedule rather than percentage table. (Sorry if any of these comments are a repeat.) Also freqency limitations are huge, so many insurance companies have gone to 2 exam/prophy per calendar year versus the 6 months. The "notes" of the insurance table is where I put that information, but I can't check that for every patient calling to schedule a recall appointment. It would be a helpful feature if it was built into dentrist so that if you tried to schedule too soon it would alert you. Dentrix please help us work together to make these much needed improvements. Thank you!
-
Sue
commented
This is a great idea... there is so much more that could be done with the insurance benefits module to make our estimates more accurate.
-
Professional Family Dental
commented
I agree with Valarie. In place of notes, there should be a way to simply have dentrix recognize the frequency. We perform preventative procedures on a routine basis and the ability to enter frequencies directly into dentrix would allow our front office staff to focus on other jobs rather than having to backtrack through patient notes just to find out if a cleaning is going to be covered.
Furthermore, if this feature becomes available, I would like to see a warning pop-up directly on the appointment book which states some thing along the lines of "Scheduling this appointment will exceede the plan allowance for Prophylaxis. Proceed anyways?" Simple yet effective. -
stephen hale, dds
commented
This would allow for much more accurate fee quotes to patients and less time and effort spent on collections, very much needed! In addition to this, different maximums for prev, basic, major would be very helpful. More and more insurance plans are seperating these out and having seperate maximums for each.
-
stephen hale, dds
commented
This would allow for much more accurate fee quotes to patients and less time and effort spent on collects, very much needed! In addition to this, different maximums for prev, basic, major would be very jelpful. More and more insurance plans are seperating these out and having seperate maximums for each.
-
Office Manager
commented
For some reason this really important feature would eliminate scheduling and billing errors - Please address this Dentrix!!
-
Valarie Stewart, CDA, RDA, CDPMA
commented
I think, rather than have to make a note about frequency limitations, it would be nice to be able to enter the frequency limitation and have Dentrix recognize that perimeter - or note that nothing was entered in that perimeter. Then, as you try to sumbit the claim, a pop up would instantly alert you to let the patient know that they would not be eligible for benefits on that claim.
-
Cindy Lemley
commented
THIS IS VERY NEEDED!!!! It would make insurance claims, etc. less of a headache... please consider this in the near future!!!
-
Comfort Family Dental
commented
Samantha's comments are exactly right. We have the same problem in our office and would really like to be able to keep the insurance claim open until it is paid in full. Our patients do monthly payments and once we receive the first insurance payment, we have to manually correct their statement.
-
Samantha
commented
This is a must feature because we are a general office, but we also do a lot of ortho. A seperate lifetime maximum for these ortho patients is needed. Looking back to see how much is left is a great feature. Also, keeping the claim open, because as we all know these insurance companies pay monthly or quarterly for these claims. Patients pay their half up front. When insurance makes their first payment the claim closes and ends up in the patient balance due, when we are still waiting on insurance to come in.
-
heathermadeline
commented
I strongly agree with this one. We have a 6 Provider practice and waste a significant amount of time hand calculation every patient that has an ins. plan where preventive care does not accrue toward the maximum. Please add this.
-
AdminRyan Beardall (Admin, DENTRIX) commented
Anonymous,
To enter notes in the current design of Dentrix, my suggestion (which I believe dovetails with Eugenia T.'s comment) is to enter a note in the Coverage Table.
Two ways to enter the note:
- Office Manager | Maintenance | Reference | Insurance Maintenance... | (select the plan) | Cov. Table... | Notes (button in bottom-left corner)
- Family File | (select patient with insurance plan) | Double-click Insurance Information block | Coverage Table | Notes (button in bottom-left corner)Where do those notes show up?
In Ledger, double-click a claim. The first portion of the note appear in the Insurance Plan Note block in the lower-right corner of the Insurance Information dialog. Double-click the note block to see the complete note.
In the Treatment Planner, two ways to view the note: Either from the 'Insurance' menu, or from the toolbar buttons, select 'Primary Dental Insurance Notes' or 'Secondary Dental Insurance Notes'
-
Anonymous
commented
new to dentrix from softdent -- softdent at least allowed us to add a note in the insurance section that showed on our routing slip based on the insurance plan -- not requiring entering it in each family file. Is there a better way to do this?
-
Linda Howard
commented
Having another benefit window for ortho would be great, and also showing if there is a deductible which applies to ortho.
-
Alex
commented
As a part of this, have the frequency limit tied to the maximum so that if a tx is done less than the limit, it automatically shows as not covered.
-
Peter
commented
YES PLEASE!
-
alecia
commented
An extra field in either the chart or family file easily accessed by both reception and hygienists when reviewing charts. We are missing out on maximizing patients insurance benefits when it is so hard to find this information, especially for a chartless practice like ours. This is needed ASAP!
-
Sully
commented
Also the maximum for the year should change when the Insurance Data Benefit Renewal comes up which 80% of the time is January but we have several April, June & Octobers. Currently to my knowlege this only updates after you close out a month, it does not make sense, so we have to updates maximums for the following year manually and of course, if the pateint goes to a specialist they use some of the max there...
