Automatically downgrade insurance coverage (e.g. composite to amalgam)
It is very time consuming to downgrade each treatment plan option that is not covered by insurance-- for example, if patients have a cavity on their back molar teeth, we have to offer both the amalgam and composite as options-- however, we must manually override their insurance coverage for the composite to what the insurance would cover for an amalgam. It would save A LOT of time if Dentrix could automate this feature.
kristin808
shared this idea
Thank you for the idea!
15 comments
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Anonymous
commented
I created the same codes only instead of starting with a D start with an M. For example: resins are being allowed more on bicuspids and downgraged on molars. Use code D2391 for bicuspids, create and use code M2391 for molars. What you have to remember to do is check the box under insurance data to repace the first character of the code with a D. Even though M2391 will show in your ledger D2391 will show on your claim. Then you can set up the percentage based on the plans guidelines and when payment is rec'd update payment table if necessary and you are pretty much covered. Only issue remaining is that some plans will cover non stress bearing surfaces only. In that case some manual calculations may be needed. This same concept can be used for sealants as well. Some plans have no tooth limitations and some are perm molars only. The option to add the D was implemented due to the inital zero on procedure codes needing to be changed to a D. So instead of having to go through and update each individual code you just checked that box and it was done for you. Now just thinking outside the box and using that feature to customize to our needs and help with treatment plan estimates.
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Angela Salmon
commented
maybe have the option when putting the specific code into the treatment plan, such as a check box that say "Replace insurance coverage with code [ ]" and be able to put the alternate coverage code in. This would also be beneficial for downgrade of coverage on crowns, or certain exams that are downgraded.
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Office Manager
commented
If composites are downgraded I calculate the % ins would pay for amalgam and input the fee manually. I hope that Dentrix would address this.
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Anonymous
commented
NOT NEEDED IN COVERAGE TABLE WE JUST SPLIT THE CODES UP AND PUT THE % AT 50 FOR AMALGAM IF THEY HAVE 80% IT WORKS OUT FINE WHATEVER THE % IS FOR COMPOSITES TAKE 30% OFF AND IT WORKS OUT PERFECT.
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Chris
commented
Here is what I do. I go into the coverage table and change the codes D2000 to D2390 to D2699- D2000-D2390. Then I make a new category for D2391 to D2394 (called Post Comps) changing the cov % to 10% less than the actual coverage for fills. If ins allows 80% I make it 70% to adjust for fee difference...then I make another new category for D2395 to D2699. This way the post comps are calculated at a lesser percentage and it makes up for the coverage difference. It sounds like a pain...but it's not so bad and it's better than having to calculate it manually and making arts and crafts all over pt's estimate.
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Shannon
commented
We were going to ask the same request. Love this idea. It is very time consuming and is not very accurate for patients.
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Anonymous
commented
This would be a REAL timesaver and prevent a lot of confusion and bad feelings for patients and staff alike!
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Peggy
commented
How would I make the proper changes on my insurance tables when it comes to insurance downgrading to amalgan. Instead of writting down covered at 70 or 80 for fillings what % should I use if I know that the insurance will downgrade.
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James McLane, DDS
commented
I agree that this is a frustrating issue and it would be nice to have a straightforward means of switching to an alternate benefit for estimates.
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BYoungDDS
commented
Treatment plans are becoming very time consuming because of the "alternate benefit" given by insurance companies. When you go to edit the procedure in the treatment plan, there should be a button or check box located in the Override Dental Ins Est section, to select whether or not a tooth should be given the amalgam or resin benefit.
PLEASE KEEP VOTING!!! -
Christine
commented
collecting payment is hard but when a patient calls angry because we have overcharged is not good for the office--it's not professional either way--when i know there are programs out there then can perform this task. you should be able to set coverage table (default coverage table) and simply add these codes without getting a message procedure codes overlap--you shouldn't have to manually put in all the fees for just these codes. i hope dentrix finds a way. I don't want to bill people and I don't want to overcharge.
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Tracy
commented
we usually set our posterior composites at 20% less coverage then their coverage says to try and compensate for the downgrade.. it helps most of the time... usually results in an over payment but its easier to credit someone back than collect sometimes!
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Christine
commented
i've tried to find a faster, easier way, but it's all very time consuming -- it would be great if there was a way to add these 4 simple codes D2391,D2392,D2393 D2394 to the coverage table to calculate correctly and save a lot of time.
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Linzee
commented
i agree!!! this is such a hassle in our office...we get too busy sometimes to even calculate by hand, and end up having to bill the patient later.
