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.
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The formulas are simple: Amalgam fee x % = ____ divided by Posterior fee. Alternate code for Crown fee x % = ____ divided by (your crown code) fee. If my puny brain can figure this out, then I know AI can do this with ease. Filling or Crown or whats-it. Molar downgrade code (pick one): check; Pre-molar downgrade code (pick one): check. I've sent them the full downgrade tables based on our specific PPOs but it's still the same precept. The fees automatically pick and calculate based on what's in your system. Remember, when you have to update all the PPO fee schedules at the end or first of the new year that have no idea how to use a spreadsheet? "Those" fees...
It would also be nice to indicate if the plan's composite downgrade is for all posterior teeth or premolars only (other than in the notes box) since some plans only downgrade premolars.
Or make the downgrade an option in each procedure code in the same area as the ins estimate override.
Adjusting the payment table to allow for posterior composite downgrades only works if its for all posterior teeth due to using the same procedure code.
Are there any updates as to when this will actually be considered and implemented? This was a waste of the developer's time if offices cannot actualyl use the exceptions table to automate checking for frequency limitations like every other software available
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.
Eagle soft does this!!!!!!!!
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.
Put the insurance payment for the amalgam in the procedure code for the resin in the update payment table.
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.
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 not...at all. :)
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.
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.
If you put in the insurance in and update payment table, this is not an issue.
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.
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?
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.
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.