Description: Correctly setting up your insurance plans, coverage, and exceptions results in more accurate treatment plans and proper patient and insurance portion estimates. The right setup can help you confidently collect the correct amount at the time of service rather than waiting to see what the insurance carrier pays and then trying to collect balances. This webinar dives into the nitty-gritty of insurance setup that will get you accurate financial breakdowns for insurance, write-offs, and patient portions.
Recommended for: new users, insurance teams, business owners, and office managers
This webinar has been split into 6 videos. Click the expansion icon on a video to watch in full screen.
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1. Adding an Insurance Carrier (17:15) 3. Building & Applying Fee Schedules (19:16) 5. Setting Up Predetermination Alerts (3:56) |
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2. Adding An Insurance Plan (6:56) 4. Setting Up Coverage Exceptions (9:10) Recap and Q&A (4:26) |
Additional Resources
Adding a New Insurance Plan
Setting Up Predeterminations Alerts
Frequently Asked Questions
Billing
How do you find out whether you bill by location or bill by provider?
From the Settings menu, select Insurance Defaults. The information under Billing Provider will tell you whether you bill by location or provider. The table below explains the three billing options available.
Can you have two doctors with different fee schedules?
If your Insurance Defaults are set up to bill by provider, each provider can utilize a different fee schedule and list of contracted carriers.
Coverage Tables
Is there a way to organize the list of Coverage Table templates?
There is currently no way to organize the list of Coverage Table templates. The templates are listed in the order that you add them. Because these are templates, you shouldn’t need very many. Best practice is to copy in from a template that is close to the carrier’s plan and make the small specific adjustments required there.
How do you set up the patient’s amount to be a specific dollar amount instead of a percentage?
When the patient portion is a fixed dollar amount rather than a percentage, you are dealing with an HMO plan rather than the more-common PPO plan. Review the section about copays in the webinar.
We have a carrier that has in-network plans and out-of-network plans. How do we handle the coverage tables for these plans in Ascend?
You must create a coverage table for each plan because coverage tables are created on a per plan basis. We recommend you build a coverage table template with 0% coverage and copy that in to make it easy. This will ensure that the out-of-network patient pays your full fee.
Fee-for-Service
If we are a fee-for-service office and we only file for reimbursement, should we uncheck all the carriers on the Contracted With list?
Yes, if you are not contracted with any insurance carriers, make sure they are NOT selected in the Contracted with list. If you have a carrier checked, Ascend will calculate write-offs depending on that carrier’s fee schedule.
Fee Schedules
Will the fees for an in-office discount plan update when the office fee schedule is updated?
No. The in-office discount plans and the office fee schedule need to be updated separately.
Insurance Benefits
When do the benefits used get updated? When the claim is created, or when the claim gets paid?
The benefits used amount gets updated when the claim is paid, meaning when the insurance payment is applied in Dentrix Ascend.
How do you know how to enter in the right exceptions for a carrier?
You can look on the carrier’s website or on a recent EOB from the carrier.
Is the patient’s deductible included on the treatment plan?
Yes, Ascend automatically checks for and includes any remaining deductible when building the treatment plan estimate.
After the deductible has been paid, will Ascend automatically take that out for the year?
Yes. And when the insurance renews, Ascend will automatically include the deductible again for the new coverage year.
If you put all the deductibles under Basic on the Benefits table, will that deductible show up for Major as well?
No. If the plan has a combined deductible, we recommend that you pick one deductible type. If you have any procedures with a different deductible type, they will not be affected. For example, if you have a $50 basic deductible and $0 major deductible, procedures with the major deductible type won’t count toward the basic deductible. Here’s an article with our recommendations for a combined deductible: Combined Deductible.
Insurance Claims
How long does a claim stay on the Unresolved Claims page?
Because a claim represents revenue for your practice, a claim will stay on the Unresolved Claims page until it is dismissed or until a payment is entered.
Should adjustments be posted when the claim is created or when the insurance payment is entered?
We recommend that the adjustments be posted when the claim is created. For more information, see The impact of the auto post ppo write-offs on the ledger and day sheet: Should you turn this on or off?
Where do you see the write-off for each insurance plan?
The write-off is calculated by taking the office UCR fee and subtracting the Carrier Fee.
You can see the write-off in the treatment plan preview by clicking the estimated guarantor portion link, and then selecting the Detailed View.
If you are using the Auto Post PPO Write-offs option, then you can also see the write-off by opening a transaction in the Ledger and selecting the Insurance Estimates tab.
Insurance Plans
We have two plans under the same carrier: one is in-network, and the other is out-of-network. How do we handle this on the Contracted with list?
Unfortunately, we don’t currently have a way to indicate in network vs. out-of-network at the plan level. This would be a great feature request. We indicate in-network at the carrier level. If you check a carrier on the Contracted with list, Ascend will treat all plans associated with that carrier as in-network.
Is there a way to find out which patients are on a particular insurance plan?
Yes. Check out this blog to learn how: Finding Patients Attached to an Insurance Carrier.