Editing exceptions in coverage table templates

You can edit exceptions in any of the coverage table templates.

Tip: You can edit exceptions in a coverage table that is attached to an insurance plan.

To edit an exception

1. On the Coverage Table Setup page, select a coverage table template.

   

   The options for editing the coverage table appear.

   

   Insurance Coverage, %

   

   Patient Copayment, $

2. Click (or tap) Manage Exceptions.

   

   The Exceptions dialog box appears.

   

3. Select an exception.

   The options for editing the exception become available.

   

4. Select a procedure code, and set up the other options on the following tabs as needed:

   • Exception Type

     1. Set up the following options:

        • Procedure code - To select a procedure, begin typing the code or its description, continue typing as needed to narrow the results, and then select a code.

        • Exception type - Select one of the following options: Not covered, Downgrade, or Coverage with age limit.

        • Pre-estimate - If the insurance carrier requires that a pre-treatment estimate (pre-authorization) be submitted before treatment can begin for this procedure, select the Required check box.

     2. Click (or tap) Next.

   • Specify Options

     1. Do one of the following:

        • For a Not covered exception type, there are no options on this tab.

        • For a Downgrade exception type, begin typing the code or description of the substitute procedure to Downgrade coverage to, continue typing as needed to narrow the results, and then select the code.

          

        • For a Coverage with age limit exception type, set up the following options:

          • Deductible Type - Select the type of deductible that the patient must pay for this procedure.

          • Coverage, % - Enter the percentage of the fee charged that the insurance carrier covers for this procedure. This option is available only for coverage tables that are based on insurance coverage percentages.

          • Copayment, $ - Enter the co-pay that the patient pays for this procedure. This option is available only for coverage tables that are based on fixed, patient copayments.

          • Max age limit - Enter an age limit to specify that the insurance carrier covers this procedure for patients who are of the specified age or younger.

          

          Insurance Coverage, %

          

          Patient Copayment, $

     2. Click (or tap) Next.

   • Reason for Exception

     Enter the reason for the exception in coverage for this procedure.

     

5. Click (or tap) Done. (This button is available only if the Reason for Exception tab is selected.)