Maintaining Insurance Plans in Dentrix




I couldn’t wait until I turned 16. My older brother had gone away to college and left his car for me to drive. I had big plans for that Datsun B-210. But soon after I was handed the keys, my big plans suddenly took an unexpected turn. I had planned on spending money to fill it up with gas, but didn’t realize there was a lot more money, time, and effort that went into the maintenance of the car. I hadn’t planned on having to pay for oil changes, tire rotations, the occasional carwash, or unexpected expenses from accidents or breakdowns. When I made the mistake of complaining about these added expenses to my parents, I was told that this was all part of being a car owner.

Managing your insurance plans takes more than simply entering plan information into Dentrix. There are ongoing types of maintenance you should do periodically to keep things running smoothly.

Joining Insurance Plans

One essential part of insurance maintenance is making sure that you aren’t cluttering up your insurance carrier database with multiple identical plans. Oftentimes your database can have multiple instances of the exact same plan due to different staff entering in information, spelling mistakes, inconsistent abbreviations, or simply not checking to see if a plan is already in the system before you add it.

The Join Insurance Carriers utility allows you to quickly move all subscribers from a source insurance plan to a destination plan and merge two insurance plans into one. You can use this utility to move subscribers from a duplicate insurance plan and combine all subscribers into the same group.

As a safeguard, Dentrix only allows you to join insurance plans when all Dentrix modules are closed.

To join insurance plans:

Join Insurance Plans
  1. Close all Dentrix modules on other networked computers and open the Office Manager.
  2. From the Maintenance menu, select Reference > Insurance Maintenance. The Insurance Maintenance dialog box appears.
  3. Click the Join Plans button at the bottom of the window. The Join Insurance Plans dialog box appears.
  4. In the Join Insurance Plans dialog box, select one of the following:
    1. Employer based – Select to move all subscribers attached to an insurance plan linked to a specific employer to another insurance plan that is linked to the same employer. Note: When selecting Source Insurance Plans and Destination Insurance plans, plans will be limited to those sharing the same employer.
    2. Plan-to-Plan – Select to join insurance plans, regardless of employers.
    3. Subscriber’s employer must match Insurance Plan Employer field – (optional) Select to move only subscribers who are assigned the same employer in the Family File.
  5. Click the Source Insurance Plan search button, and in the Select Dental Insurance Plan dialog box, select the insurance plan that you want to join with the destination insurance plan and click OK.
  6. Click the Destination Insurance Plan search button and in the Select Dental Insurance Plan dialog box, select the insurance plan that you want to join the source insurance plan to and click OK.
  7. Be sure to heed the warning that appears at the bottom of the dialog box before clicking the Join button. A message appears. To move all subscribers from the source insurance plan to the destination insurance plan, click Yes.

A confirmation message appears at the completion of the merge or if no subscribers matching the criteria associated with the source insurance plan exist.

Removing Duplicate Insurance Plans from Dentrix

Often, insurance carriers and plans are inadvertently entered into the system multiple times. This can cause confusion and problems when entering batch insurance payments or updating coverage tables, payment tables and other insurance information.

Remedying the situation is simple. First, join the insurance plans (following the steps in the above section), and then purge the duplicate plan that no longer contains any patient information.

To remove a duplicate plan:

  1. From the Maintenance menu in the Office Manager, click Reference > Insurance Maintenance. The Insurance Maintenance dialog box appears.
  2. Click the Purge button, which will open the Purge Dental Insurance Plans dialog box. A list appears showing all insurance plans that are not attached to subscribers and for which there are no outstanding claims.
  3. Select the individual plan from this list you want to delete, and then click the Delete button, or to delete all plans visible in this list, you can select Delete All.

If the insurance plan you want to delete does not appear on the list of plans to delete, a patient or outstanding claim is still attached to it. You must clear the plan from the patient’s Family File before you can delete it. To find the patient to which the plan is still attached, print the Insurance Carrier List for that plan.

By removing duplicate insurance plans, you will avoid the likelihood of data-entry mistakes caused by selecting the wrong insurance plan.

Updating Coverage Tables

One of the first things you do when entering a new insurance plan into Dentrix is enter coverage table information. A coverage table can include a schedule of benefits declaring the maximum annual benefits for individuals, as well as benefits for the entire family. Coverage tables also can include deductible amounts, plan maximums and the percentage of the “usual and customary fee” that the insurance company will pay. Entering this information into the insurance plan’s coverage table will help you get more accurate insurance estimates for claims.

Once you enter this information, you’ll want to maintain the coverage table with any new or updated information that becomes available. As you receive new coverage information or changes to plan benefits, you should enter that information into the coverage table.

To update a coverage table:

  1. From the Office Manager select Maintenance > Reference > Insurance Maintenance. The Insurance Maintenance dialog box appears.
  2. Click the Cov Table button.
  3. Edit the coverage table as needed and click OK. A warning appears notifying you that the changes you made the coverage plan will affect all patients assigned to this plan.

Updating Payment Tables

The payment table keeps track of past insurance payments on a per-procedure basis. It then uses that information to more accurately predict what the insurance plan will pay for that procedure in the future. Part of an active and accurate collections process should be routine, correct, and comprehensive updating of payment tables.

A payment table is created for each new insurance plan entered into Dentrix. The payment table collects information through the Itemize by Procedure payment process and then uses that information to override the information entered in the coverage table. To make sure that your patient portion estimates are accurate, you should be posting insurance payments using the Itemize by Procedure option.

As you itemize payments, you’ll enter the procedure’s payment amount if it’s different from the Dentrix estimate that automatically appeared. To save the paid amount as a reference for future estimates, click Yes under Update Payment Table.

Join Insurance Plans

Note: When you itemize estimates or payments, it is important that you only update the payment table when the payment amount applies to all patients covered by that plan. For example, if the estimated insurance portion is different from the payment amount because money is being withheld toward a deductible, do not update the payment table. Similarly, if a patient has exceeded his or her maximum benefits, or if payment is reduced because a missing tooth clause or time limitations apply, do not update the payment table.

Just as keeping a car running requires certain ongoing maintenance on the part of the car owner, so does maintaining your insurance plans in Dentrix. For a database that runs smoother, it is vital to plan time in your work schedule for periodic maintenance of your insurance plans.

Resources

To learn more about purging insurance plans, see the “Deleting Insurance Carriers” topic in the Dentrix Help files.

To learn more about joining insurance plans, see the “Joining Insurance Carriers” topic in the Dentrix Help files.

To learn more about updating coverage tables, see the “Adding a Coverage Table and Editing a Coverage Table” topics in the Dentrix Help files.

To learn more about updating payment tables, see the “Posting Insurance Payments”, “Adding a Payment Table”, and “Editing a Payment Table” topics in the Dentrix Help files.



Author: Sean Eyring
Published: 07/31/2013
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