Setting Up Insurance Plans

This topic identifies the fields you should complete when adding various insurance plan types in SoftDent. The information required for each insurance plan type—Indemnity, PPO, DMO/Capitation, or Medicaid—varies when combined with the insurance estimation type.

For All Plan Types

Set up the bluebook with plan fees.
In the Patient window, type the Insurance ID in the Insurance ID field.
Check with eServices for specific Sub Type.

Flat Fee Plans

On the Information tab, complete the following fields:

Estimation Type—Select Flat Fee.
Sub Type—Select Indemnity.

Percentage Plans

On the Information tab, complete the following fields:

Estimation Type—Select Percentage.
Sub Type—Select Indemnity.

PPO Plans

On the Information tab, complete the following fields:

Estimation Type—Select either % PPO or Flat Fee PPO.
Sub Type—Select Preferred Provider Organization.
Risk Write-Off—Type the write-off percentage.
Post Write Off at time of service—Select this option to post the write-off amount when a procedure is posted.
Link an allowance table to the plan to create the bluebook automatically.

DMO Plans

On the Information tab, complete the following fields:

Estimation Type—Select DMO.
Sub Type—Select Dental Maintenance Organization.
Anniversary Month—Select None if there is no anniversary month.
Maximum Coverage—Deselect this option if there is no maximum coverage.
Charge Per Visit—Type the charge per visit as specified by the plan.

On the Coverage tab, select each procedure code range that is covered, and type each copay amount.

On the Claim Filing tab, deselect the Print Form option if no insurance form is required to print.

Medicaid Plans

On the Information tab, complete the following fields:

Estimation Type—Select Medicaid.
Sub Type—Select Medicaid.
Anniversary Month—Select None if there is no anniversary month.
Maximum Coverage—Deselect this option if there is no maximum coverage.

On the Coverage tab, select each procedure code range that is covered, and enter each copay amount.

On the Claim Filing tab, complete the following fields:

Print UCR—Select this option to print your usual fees on the claim form.
Treat Patient as Guarantor—Select this option to have the patient display as the responsible party on the insurance claims.

To view a printable job aid about setting up insurance plans, see Setting Up Insurance Plans.