Having problems with the estimated guarantor portion in the treatment planner? You’re in good company; this is consistently among the top-10 reasons customers call Dentrix Ascend Support. The good news is most fixes are simple once you understand the workflow.
Watch this webinar to learn how to verify your setup and resolve problems to get the right numbers in your treatment plan estimates.
Click any of the following links to jump to the corresponding time in the video:
Introduction to Treatment Planner (3:12) Understanding the Estimated Guarantor Portion (4:18) Discover
how to use the Detailed View to troubleshoot treatment plan estimates.Verifying Your Billing Setup (15:28) Learn
how to check your billing setup to avoid inaccurate treatment plan estimates.Verifying Insurance Eligibility (27:19)
Learn how to verify insurance eligibility so you can discuss treatment plans
estimates with confidence.Attaching Insurance Fee Schedules (36:50) Find
out how to fix inaccurate write-off adjustments in the treatment planner.Q&A (42:32)
(Duration: 52:46)
Additional Resources
Understanding the Estimated Guarantor Portion
Verifying Insurance Eligibility
Attaching Insurance Fee Schedules
Frequently Asked Questions
Billing Setup
If we have been billing by provider, how can we switch to billing by location?
- You will need to update your Insurance Defaults. From the Settings menu, select Insurance Defaults. Under Billing Provider, be sure that Specific Provider is selected. Then from the dropdown, select your location name.
- From the Settings menu, select Location Information. On the Basic Info tab under Preferred fee schedule, select your office’s fee schedule.
- Verify the carriers your practice is contracted with. From the Settings menu, select Location Information. Select the Claim Provider Under Contracted with, click the expansion arrow next to a letter to see the list of insurance carriers. Verify that the correct insurance carrier(s) are selected. Edit as needed and click Save.
- Check each provider’s User Account to ensure that there is no fee schedule attached.
Fee Schedules
Can we update the amount that a carrier pays on a specific procedure?
If you would like to change the amount for all patients on this plan, from the Settings menu, select Fee Schedules. Here you can edit the procedure fees for your office and for specific insurance carriers. If you update an insurance fee schedule, the procedure amount in all related treatment plans will update.
If you would like to change the amount only for a specific patient, click the procedure link in the treatment plan. Click the Insurance Estimates tab. Click the lock icon. You may need to ask an admin to enter their credentials. Check the insurance box (primary or secondary). Enter the amount. Click Save.
If we bill by location, should our providers have a fee schedule attached to their user account?
If you bill by location, your providers should NOT have a fee schedule attached to their user accounts. If you have a fee schedule attached to a provider, this fee schedule will override the location fee schedule. This would lead the treatment planner to calculate differently.
Fee-for-Service and Out-of-Network
If we are out of network, do we need to upload a fee schedule?
You can leave the fee schedule under the insurance plan blank, and the treatment planner will use the UCR fee schedule and will not have any write-offs.
We are fee-for-service and not contracted with any insurance. Can we turn off the insurance estimates on treatment plans?
Yes. Note however there is no way to turn off insurance estimates for all procedures at once. You need to go into each procedure and turn off the Bill to insurance switcher. To do this, from the Settings menu, select Procedure Codes and Conditions. Search for and select each procedure. Switch the Bill to insurance switcher to Off. Start with your most common procedures rather than trying to tackle them all at once.
If we are out-of-network with a carrier, how can we make sure the insurance estimates are accurate in the Tx planner?
If you bill by location: From the Settings menu, select Location Information. Click the Claim Provider tab. Expand the carrier list by letters (A, B, C, etc.) and make sure no carrier name is selected. If any are, uncheck the insurance carrier under Contracted With and click Save. When you create a claim for the patient, it will show out-of-network fees.
If you bill by provider: From the Settings menu, select User Account. Search for and select the provider. On the provider’s User Account page, click the Fees tab and uncheck the insurance carrier under Contracted With. Then click Save. When you create a claim for the patient, it will show out-of-network fees.
Insurance Benefits
How do I manually update a patient’s met deductibles and benefits remaining?
Learn how to manually update a patient’s met deductibles and benefits in this article: Updating a patient’s met deductibles and used benefits.
If the plan deductible goes toward both Basic and Major combined, why does Ascend apply it separately?
Ascend allows you to separate the deductible between Basic and Major procedure types. If the plan only has one type of deductible, our recommendation is to set the deductible type to Basic for all procedures.
When does the benefits used amount get updated?
The benefits used amount updates when the insurance payment is posted.
Insurance Coverage
Can I edit the estimate co-pay per line item?
Assuming the patient’s insurance is assigned to a co-pay coverage table, click the procedure link in the treatment plan and edit the amount in the Edit Procedure window.
You can find this information in the Detailed View. In the treatment plan preview, click the Estimated guarantor portion link to open the Guarantor portion page. Then click Detailed View.
- In the Primary Insurance Portion Remaining column, click the blue hyperlinks for each procedure to view the remaining benefits.
- In the Primary Deductibles Remaining column, view the deductible amount.
See Viewing the details of an estimated guarantor portion for a treatment plan.
Do I need to add downgrades from EOBs that we receive?
Yes. The Treatment Planner recognizes exceptions and includes them in the calculation. If the downgrade applies to all patients on the plan, we recommend you create an exception for the downgrade in the coverage table. See Adding exceptions in coverage table templates.
Can I downgrade procedures on specific teeth?
No. You cannot add exceptions for specific teeth. However, you can add exceptions for procedures, such as composite restorations (fillings). See Adding exceptions to coverage tables.
Insurance Eligibility
Where do I check patient eligibility?
From the Schedule menu, select Insurance Eligibility. Eligibility is automatically checked four days before a patient’s appointment. If there was a problem with the eligibility check, the patient will remain on the Unable to Verify page. Some carriers do not accept automated eligibilities and must be contacted manually. If you contact a carrier and find that a patient is not eligible, click Ineligible to move the patient to the Ineligible tab. Patients who are eligible will be found on the Eligible tab. See Checking Insurance Eligibility.
When Ascend automatically checks a patient’s eligibility and the patient is rejected, how is my practice informed?
If there was a problem with the eligibility check, the patient will remain on the Unable to Verify tab of the Insurance Eligibility page. Click the paper clip icon to see the response from the payer. See Checking Insurance Eligibility.
Treatment Planner
Can I create an appointment directly from the Treatment Planner?
Learn how to schedule from the treatment planner in this video: Scheduling Appointments from the Treatment Planner.
Where do I find the Guarantor Portion page in the treatment planner?
In the Treatment Plan tab, open a treatment case, and click Preview. Click the Estimated Guarantor Portion link to access the Guarantor Portion page.
Is there a way to change the plan percentage straight from the treatment planner?
No. You need to open the insurance coverage table and change the percentage there. This will allow the change to be reflected on future treatment plans for all patients with that insurance plan. See Editing coverage tables.
If we don’t know the insurance allowable fee for a seldom-used procedure code, is it okay to leave the fee at 0.00?
No. If you leave a fee at $0.00, Ascend will assume that $0.00 is the covered amount and will write the entire procedure off. If you don’t know , as a temporary solution, we recommend that you enter the office fee to avoid having to write off the entire procedure. We also recommend that you contact the insurance carrier to get the updated fee schedule so that you can add that to Ascend. See Editing coverage tables.