You can edit the coverage table that is attached to an insurance plan. A coverage table references the procedures that a carrier covers and either the percentage covered or the patient copayment. Along with deductibles and benefits, a coverage table allows for accurate insurance estimates.
Tip: You can also replace the coverage table of any given insurance plan with the coverage table from any other plan or from a coverage table template.
Important:
Changing an insurance plan's coverage table affects all patients who are covered by that insurance plan.
Changing a plan's coverage does not update the fees that are associated with treatment-planned procedures. You must either edit the fees manually for the procedures in a treatment plan case or delete and re-create the case and procedures.
To edit a coverage table
On the Home menu, under Insurance, click (or tap) Carriers.
The Insurance Carriers page opens.
Select an insurance carrier.
The options for editing the insurance carrier become available.
Under Plans/Employers, select an insurance plan.
The options for editing the insurance plan become available.
Click (or tap) Coverage Table.
The Coverage Table dialog box appears.
Insurance Coverage, %
Patient Copayment, $
If necessary, you can change the type of coverage table. From the Type list, select either Insurance Coverage, % or Patient Copayment, $ to specify whether the coverage should be based on a percentage or a fixed amount, respectively.
Notes:
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If you change the type from Insurance Coverage, % to Patient Copayment, $, the coverage table changes to either the previous version of the patient copayment ($) type coverage table for this plan or, if this is the first time that you have changed the type, the default patient copayment ($) type coverage table.
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If you change the type from Patient Copayment, $ to Insurance Coverage, %, the coverage table changes to either the previous version of the insurance coverage (%) type coverage table for this plan or, if this is the first time that you have changed the type, the default insurance coverage (%) type coverage table.
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If necessary, you can replace the coverage table with that of a template or another plan, or you can delete the coverage table to make a new one from scratch (not recommended).
Do one of the following:
For an Insurance Coverage, % table, add, edit, and delete the procedure code ranges as needed.
Do the following:
Click (or tap) Add Range to add a procedure code range, or select an existing range to edit that range.
Set up the following options for that range as needed:
Code Range - The ADA or custom procedure code range. These boxes accept dashes (-), periods (.), numbers, and letters, and they can be up to 10 characters in length. Make sure there are not any overlaps and gaps in the sequence between the starting and ending codes in the range and between other ranges.
You can include an alias procedure codes in a range by typing a period (.) in either box. The Code Range boxes change to allow for entering suffixes. Enter a suffix in either or both suffix boxes. If you need a period in either of the main code boxes (the boxes to the left of the suffix boxes), you must type the period again in that box.
Note: When you change a range and then click (or tap) somewhere else, the text of the range that you modified turns bold. Also, any ranges that overlap or that are invalid become highlighted in red, and you cannot save the changes to the coverage table until those errors are resolved.
Category - The procedure category for the procedures in the range.
Deductible Type - The type of deductible that the procedures in the range apply to.
Coverage % - The percent that the insurance carrier pays on covered charges (after any deductible, up to any allowed amount, and up to any maximum allowed benefit) for procedures in the range.
Repeat the steps a - b for any other ranges that you want to add or edit.
To delete a range, click (or tap) the corresponding Remove button
, and then click (or tap) Delete on the confirmation message that appears.Important: If you are deleting the only range in the coverage table, the entire table will be deleted.
For a Patient Copayment, $ table, add, edit, and delete the procedure codes as needed.
Do the following:
To add procedures codes, do the following:
Click (or tap) Add Procedure.
The Add Procedures dialog box appears.
Select the check boxes of the procedure codes that you want to add to the coverage table. You can select or deselect the check box in the column header to select and deselect all the procedure codes at the same time.
Click (or tap) Add Checked.
Note: If you are adding procedure codes to a coverage table that already has procedure codes, the procedure codes are added at the top of the table, which might not be the correct order; however, when you save the template, the procedure codes will be listed in the correct order.
To edit an existing or newly-added procedure code, select it.
Set up the following options for that code as needed:
Deductible Type - The type of deductible that the procedure applies to.
Copayment $ - The patient co-pay. Patients will pay the specified amount for the procedure.
Repeat the steps a - c for any other codes that you want to add or edit.
To delete a code, click (or tap) the corresponding Remove button
, and then click (or tap) Delete on the confirmation message that appears.Important: If you are deleting the only code in the coverage table, the entire table will be deleted.
To add, edit, or delete exceptions to the coverage for specific procedures, click (or tap) Manage Exceptions.
Do one of the following:
To apply the changes to the coverage table and create a new coverage table template using the specified coverage options, click (or tap) Save As New Template. In the New Coverage Table Template dialog box that appears, enter a name for the template, and then click (or tap) Save.
To apply the changes to the coverage table, click (or tap) Save.
Click (or tap) Save or Cancel.
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