PracticeWorks estimates insurance payments using information entered into the Employer/Plan window and the plan’s blue book. The blue book tracks what each plan currently pays for charges submitted by your practice.
When you enter an insurance payment, PracticeWorks first looks in the blue book for an entry that matches that particular Employer/Plan and the procedure code. If it finds a match, the default amount in the blue book is used to calculate the difference between the current charges and what the patient’s insurance plan will pay. This difference is the estimated amount for which the patient is responsible.
When estimating the cost of a procedure, PracticeWorks searches for information in the following order:
Employer Plan, code specific
Employer Plan, benefit table
Insurance Company, code specific
Insurance Company, benefit table
Office-Wide Default, code specific
Office-Wide Default, benefit table
ADA Code Default Percentage
Importing and Exporting Benefit Tables
Using the Blue Book Entries Feature
Displaying the Insurance Company List