Adding Insurance Plans

You can add percentage, flat fee, preferred provider, DMO/Capitation, Medicare, and Medicaid plans.

To add an insurance plan:

  1. Select List > Ins. Plan. The Insurance Plan List window is displayed.

  2. Press Enter. The name of the insurance company is displayed in the title bar.

  3. Click Add. The Insurance Plan window is displayed. The identification number for the new insurance plan is displayed next to the Plan ID field.

  4. If you subscribe to Trojan, select a Trojan carrier identification number from the Trojan ID drop-down list.

  5. Type the insurance plan name.

  6. Select the insurance company that sends payments from the Insurance Co drop-down list, select the insurance company office to send claims to from the Mail To drop-down list, and if the insurance plan is associated with only one employer, select it from the Default Employer drop-down list.

  7. Type any phone numbers and notes.

  8. Press Alt + Enter to move the cursor to the Information tab and type the plan's group number in the Group Number field.

  9. Select an option from the Plan Type drop-down list:

  1. Select the estimation type from the Estimation Type drop-down list:

  2. If the insurance plan uses a flat fee rate:

  3. If the insurance plan pays a percentage of procedural costs:

  4. If the insurance plan pays a percentage of the procedural costs based upon your allowed amounts:

  5. If the insurance plan pays a flat fee for procedural costs:

  6. If the insurance plan negotiates a reimbursement amount for procedural costs:

  7. If the insurance plan pays a flat fee for procedural costs based upon the Medicare plan’s allowed amounts:

  8. If the insurance plan pays a percentage of the procedural costs based upon the Medicare plan’s allowed amounts:

  9. If the insurance plan negotiates a reimbursement amount for procedural amounts for patients on medical assistance or welfare:

  1. Select the month within which the plan’s deductible and year-to-date benefits are reset from the Anniversary Month drop-down calendar. If the plan has a lifetime deductible, select None/Other.

  2. Select an option:

  3. After the maximum coverage amount is reached, the estimated insurance amount is 0. Treatment plan procedures affect this amount after they are completed and posted.

  1. Click OK.

  2. If you are entering a dental or medical flat Medicare, percentage Medicare, percentage PPO, or flat fee PPO estimation type and want to post the write-off at the time of service, select Post Write Off at time of service.

  1. If you are entering a dental or medical flat Medicare, percentage Medicare, percentage PPO, or flat fee PPO estimation type and the plan requires an additional risk and development write-off, type the percentage in the Risk Writeoff % field. This amount is automatically calculated when an insurance payment is posted.

  2. These fields are not enabled for percentage, flat fee, DMO/Capitation, and Medicaid insurance plans.

  1. Click the Coverage tab or press Ctrl + Tab and enter insurance coverage information for each procedure class on this tab. This information is used to estimate the patient and insurance portions of fees. Dental and medical procedures are classified differently.

  2. Select an option:

  3. If you are entering a medical percentage, PPO percentage, flat fee, flat fee PPO, flat medicare, or flat Medicare percentage:

  4. If you are entering a dental percentage, flat fee, PPO percentage, flat fee PPO, flat Medicare percentage, or Medicare percentage insurance plan and deductibles apply for the procedural group:

  5. If you are entering a dental or medical DMO/Capitation or Medicaid plan and the procedural class is covered:

  1. If there is a waiting period before which the procedure is not covered, select Wait Pd and type the number of months in the Mos field.

  2. Click the Claim Filing tab or press Ctrl + Tab. Claim form and eClaims information is displayed on the tab.

  3. Select an option:

  1. To print a claim each time you submit a transaction for a patient covered on the plan:

  2. To scale the copyright information to print on one page:

  3. To print an alternative insurance code instead of the procedure code on Medicaid claim forms:

  4. To submit diagnosis codes with dental codes:

  1. If the plan belongs to an insurance company that accepts electronic primary dental insurance claim filing for secondary claims:

  2. If the plan accepts electronic treatment plan preauthorization claims:

  3. If the plan provides coverage for ortho procedures and requires claim resubmission:

  4. If the plan provides coverage for ortho procedures and requires coupon resubmission or continuous care forms:

  5. To treat the patient as the guarantor of claims associated with the insurance plan:

  6. To estimate the secondary insurance amount based on the total fee minus the deductible, minus the amount already estimated to be paid by the primary plan:

  7. To print discount transactions on the claim form:

  8. To specify whether a plan accepts "Signature On File" for the Billing and Treating Drs signature areas on a claim form:

  1. Click the Contact Info tab or press Ctrl + Tab.

  1. Type additional phone numbers and e-mail addresses.

  2. Click OK.

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Related Topics

Setting Up Insurance Plans