Using Maintenance Functions

Setting Up Carrier Coverage

After you have added a new insurance carrier, you can set up the amount of coverage the carrier pays for each procedure. Charges are attached to your procedure codes, and you can enter the total amount the carrier pays and the amount for which the patient is responsible.

To enter carrier coverage:

1. In the OrthoTrac Carrier Lookup window, select the carrier and click Change. The Carrier Maintenance window is displayed.

2. Click Coverage. The Insurance Coverage window is displayed.

3. Click the Lock icon in the right corner of the window to set the status of the carrier to Locked or Unlocked.

• If you edit the procedure codes and then make a global change, the changes do not apply to carriers you have locked.

4. Select the coverage type for the carrier by clicking one of the following options:

5. Variable—The carrier pays different percentages for different procedures; for example, 100% for records, 80% for exams, 50% for treatment.

6. Fixed—The carrier pays the same percentage for all procedures; for example, 50%. If you select Fixed, type the percentage amount, and the software assigns this amount to all procedures.

5. Select the first procedure code that you want to edit for this carrier and type information in the following columns:

• ADA—The ADA code assigned to this procedure.

• Fee—The doctor’s charge, posted to the responsible party’s ledger.

• Ins—The amount printed on the insurance claim, which is the maximum amount the carrier pays. This amount can never be more than the doctor’s fee.

• Coverage—The percentage of the charge the carrier actually pays. If you selected Fixed and typed a percentage, the Coverage column is automatically populated and cannot be changed.

6. Click OK.

Related Topics

Adding New Carriers

Adding Employers

Setting Up the Financial Estimator

Adding Referral Sources

Adding Outside Doctors

Setting Up Patient Flow

Adding Calendar Days Using Schedule Maintenance

Skill Sharpeners