Insurance Estimates Using Payment Tables

With this new phase of the payment table features, you can enable or disable payment tables to respectively allow or prevent the amounts entered for procedures in payment tables to override coverage tables percentages. Initially with this update, payment tables do not affect insurance estimates; to allow payment tables to be used for calculating insurance estimates in your organization, you must turn on a new setting.

To allow payment tables to override coverage tables, do the following:

1. On the Settings menu, select Ledger Options to open the Ledger Options page.

2. Select the Ledger Rules tab.

3. Set the Payment Table amounts should supersede coverage tables switch to Yes.

Notes:

  • If the option is set to No, payment tables do not affect estimates, and a message appears in the payment tables of insurance plans (go to Home > Carriers, select a carrier, select a plan, and click Payment Table) to indicate that.
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  • If the option is set to Yes, payment tables can affect estimates:
    • If there is an override at the procedure level, that amount is used as the insurance portion instead of the amount in the payment table.
    • If the procedure exists in the payment table, that amount is used as the insurance portion.
    • The write-off for the remaining amount is based on the coverage table.
    • Whether or not payment tables are used, the insurance portion cannot exceed the procedure amount, the patient portion is equal to the procedure amount minus the sum of the insurance portion and the write-off amount, and estimates take used benefits and deductibles into account.

4. Click Save.

Notes:

  • Viewing the ledger options, including the payment table setting, requires the existing “Review ledger options” security right.
  • Enabling/disabling payment tables requires the existing “Manage ledger options” security right.
  • As in previous versions, estimates appear in the following areas of Dentrix Ascend:
    • Calendar – Scheduled net (appointment, day, totals).
    • Ledgers.
    • Statements.
    • Treatment plans.
    • Estimate details.
  • When you are viewing estimate details, if a payment table is in use for a procedure, that procedure’s amount is orange, and if you click the amount, a Payment Table In Use pop-up message appears for your reference.
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