Dentrix Ideas

Automatically downgrade insurance coverage (e.g. composite to amalgam).

It is very time consuming to downgrade each treatment plan option that is not covered by insurance-- for example, if patients have a cavity on their back molar teeth, we have to offer both the amalgam and composite as options-- however, we must manually override their insurance coverage for the composite to what the insurance would cover for an amalgam. It would save A LOT of time if Dentrix could automate this feature.
  • Guest
  • Jul 9 2019
  • Future consideration
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  • Stacy Borucki commented
    8 Dec, 2023 08:23pm

    You can go to the payment table of the ins plan that has the ABC (Alternate Benefit Clause aka: downgrades) applied. You add the code of the the posterior composite and the calculate the % of what plan pays on the amalgam, enter that under paid column. I have programmed the payment tables for years this way.

  • Suzanne Lane commented
    17 Oct, 2023 05:07pm

    Eagle soft does this!!!!!!!!

  • dexter b commented
    19 Jun, 2023 08:37pm

    Is there any office that would NOT want this ????? instead of sending us 3 emails a week on Dentrix text-to-pay being available, please work on implementing this. Approaching 4 yr anniversary of this post. I am sure there are even older request for this enhancement.

  • Barbara Capote commented
    10 Oct, 2022 02:46pm

    Put the insurance payment for the amalgam in the procedure code for the resin in the update payment table.

  • Guest commented
    1 Jul, 2022 03:07pm
    Primary issue is Dentrix DOES NOT put any time, effort, experienced employees, or investment in upgrading and perfecting their software to Client requests or even in keeping themselves on top of yearly changes with how insurance is managing things...I CAN TELL YOU FROM EXPERIENCE THEY DON'T CARE!!!...AND THEIR CUSTOMER SERVICE IS BEYOND POOR AND INCAPABLE!!!
  • Chad Belongea commented
    22 Apr, 2022 02:51pm

    HOPEFULLY SOON entering the downgrade into the "exceptions" area should make this work. I think the best way to get the most accurate estimate, Dentrix should calculate the ins portion from the alternate code allowable fee schedule (amalgam code, gold crown code, base metal crown code for Cigna). Also we need the option to estimate the pts portion off of a different insurance allowable fee schedule. This should be separate fee schedule selections for the both the ins payment estimate and patient portion for those of us that are Delta Premier providers and the ins portion is based off PPO fees and the pt portion is the difference between that ins portion and the Premier allowable fee. This section should be combined with all the other request for this, I know I requested this same improvement 15+ year ago.

  • Guest commented
    7 Mar, 2022 10:46pm

    I have asked Dentrix to do this multiple times. The problem is that they don't understand the basics of what the insurance companies are actually doing with "alternate benefits" or "downgrades" so the system is unable to pull the fees and recalculate. The benefit exceptions I now enter are just fluff and fodder and make my job so laborious that I want to hang myself at the end of the day because they don't make my tasks more efficient but less so than ever before. I'm hoping there's a silver lining somewhere behind all this data entry that's made to look like it's something when it's really all. :)

  • Guest commented
    12 Oct, 2021 02:53pm

    Make the exceptions & allowed amounts actually work when entering new insurance. Doesn't make since to use the exceptions box if it doesn't work with the system! Currently it is to sit there & look pretty.

  • Bradford Plasha commented
    24 Apr, 2021 10:58am

    Payment table does not consider different teeth. I have an insurance carrier that downgrades crowns on molars to D2791 and on premolars to D2752. We still manual calculate on these plans. Also a payment table will need to recalculated every year while if the exceptions table worked it would not require as much calculation.

  • Guest commented
    13 Jul, 2020 10:48pm

    If you put in the insurance in and update payment table, this is not an issue.

  • Guest commented
    22 Jun, 2020 04:14pm

    You have the option to enter down grades in the payment table. Once you enter that plan it saves it for anyone who has that plan (based off of group #) You do have to do the math manually when you 1st set up the plan, but you don't have to do it every time you TP. Its actually quite simple, once you get use to it.

  • Guest commented
    2 Jun, 2020 10:31pm

    Not everyone in our practice has rights to go into the payment tables (by admin preference) and so a box to just check whether the amalgam downgrade applies in the coverage table or some other dialog box for the policy would streamline this so much better. Amalgam downgrades have been a thing for how long now?

  • Nathan Saydyk commented
    12 Jan, 2020 05:27pm

    Actually, I just researched Payment Tables and it is super easy....however it still requires manual entry for every plan rather than having a checkbox or something super simple.

  • Nathan Saydyk commented
    12 Jan, 2020 05:23pm

    I will vote for this ability also.  Right now I have a book with spreadsheets that calculate the downgraded fee and we just override the insurance estimate and manually enter the correct fee do pt portion is calculated correctly.  It seems like this can be automated in some way.  I understand that the Payment Table is how it is suppose to be done but it is not intuitive in any way.

  • Guest commented
    9 Jul, 2019 04:23am
    i agree!!! this is such a hassle in our office...we get too busy sometimes to even calculate by hand, and end up having to bill the patient later.
  • Guest commented
    9 Jul, 2019 04:23am
    i've tried to find a faster, easier way, but it's all very time consuming -- it would be great if there was a way to add these 4 simple codes D2391,D2392,D2393 D2394 to the coverage table to calculate correctly and save a lot of time.
  • Guest commented
    9 Jul, 2019 04:23am
    It would be ideal if there was a button that we check if amalgam fills are downgraded and then when we give a treatment estimate is automatically factors in the fee. I've been waiting this for happen for years!!!!!
  • Guest commented
    9 Jul, 2019 04:23am
    we usually set our posterior composites at 20% less coverage then their coverage says to try and compensate for the downgrade.. it helps most of the time... usually results in an over payment but its easier to credit someone back than collect sometimes!
  • Guest commented
    9 Jul, 2019 04:23am
    collecting payment is hard but when a patient calls angry because we have overcharged is not good for the office--it's not professional either way--when i know there are programs out there then can perform this task. you should be able to set coverage table (default coverage table) and simply add these codes without getting a message procedure codes overlap--you shouldn't have to manually put in all the fees for just these codes. i hope dentrix finds a way. I don't want to bill people and I don't want to overcharge.
  • Guest commented
    9 Jul, 2019 04:23am
    Treatment plans are becoming very time consuming because of the "alternate benefit" given by insurance companies. When you go to edit the procedure in the treatment plan, there should be a button or check box located in the Override Dental Ins Est section, to select whether or not a tooth should be given the amalgam or resin benefit. PLEASE KEEP VOTING!!!
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