Editing coverage tables

You can edit the coverage table that is attached to a patient's insurance plan. You can edit the coverage table that is attached to an insurance plan. A coverage table references what procedures a carrier covers and at what percentage. 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 covered by that insurance plan.

To edit a coverage table

1. Do one of the following:

   • While viewing an insurance plan that is attached to a patient's record, click (or tap) Coverage Table.

     

   • While viewing an insurance plan that is associated with a specific insurance carrier, click (or tap) Coverage Table.

     

   The Coverage Table dialog box appears.

   

2. 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).

3. Add, edit, and delete the procedure code ranges as needed.

   Do the following:

   1. Click (or tap) Add Range to add a procedure code range, or select an existing range to edit that range.

      

   2. 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.

      • Co-pay $ - The patient co-pay for capitation plans. Patients will pay the specified amount for the procedure (do not use more than one procedure in a range when working with the coverage table for a capitation plan).

   3. Repeat the steps a - b for any other ranges that you want to add or edit.

   4. To delete a range, click (or tap) that range's 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.

4. To add, edit, or delete exceptions to the coverage for specific procedures, click (or tap) Manage Exceptions.

5. 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, type a name for the template, and then click (or tap) Save.

     

   • To apply the changes to the coverage table, click (or tap) Save.

6. Click (or tap) Save or Cancel.