Do you accept any DHMO or fixed copay fee schedules in your practice? If so, you may have wondered how to set up these plans to make sure that you are presenting accurate fees and co-pays to your patients. Here are the instructions to set up fixed copay plans. Note that the Co-pay $ amount in the coverage table is not used to calculate the insurance and patient portions on the treatment planner or the patient ledger. It is for information only.
To create a coverage table for fixed co-pays
1. First you need to know the numbers. Get a copy of your insurance contracted fee schedule and the fixed copays by procedure code.
2. Set up a calculator in Excel. In the first row you will enter the fee, and in the second the copay amount, and in the third you will create a calculation for the coverage percentage.
- Add labels next your data entry places to help you keep track of what goes where. It might look something like this:
- The key calculation is to convert the copay percentage into the coverage percentage, which is done like this:
- Click the Excel Percent Style button to make the calculated value display as a percentage, and then click the Increase Decimal button until you get three values to the right of the decimal point.
3. If this is your first time configuring a coverage table this way, start with a template. Go to Settings > Coverage Tables. Select an existing template or click the New Coverage Table button to create a new empty table. Name the template.
4. Add your procedure code configurations. You can add procedure code ranges, or you can use the same code as the beginning and ending of the range to make the coverage specific to that code.
- Name the category or procedure
- Set the Deductible Type to None
- Enter the coverage percentage up to three decimal places
5. Click Add Range and repeat to add ranges for all the procedures you are likely to submit to an insurance carrier, based on what you do in your organization.
6. Apply your template to a specific insurance plan. From the Home menu under Insurance select Carriers. Click to select the carrier name, and then click to select an existing plan or add a new one.
7. In the plan editor, click Coverage Table. Click the Select coverage table template dropdown and click the name of your fixed copay template to load the configuration.
- For any procedures that does not have a copay, set the coverage to 100%.
- You can edit an existing coverage table if you don’t want or need to create an entirely new one.
- Import your template as a starting point for any plan. You can modify individual ranges as needed.
- To learn more, read Editing coverage tables in the Help Center.
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