Insurance Procedures > Preliminary Insurance Information
Beginning in version 10.0.2 of the software, WinOMS enables you to set up insurance plans for estimating. To enable this feature, you must first update settings for the practice, and then for each affected plan.
To update settings for the practice:
Select Tables > Practice > Practice Preferences. The Practice Data Entry window is displayed.
Select the Insurance tab, and then select Detailed Calculation.
Click Ok.
Insurance plans often have different default coverage percentages for different categories of treatment. WinOMS estimates coverage using the following hierarchy:
Covered % for a procedure code, from the allowable schedule selected for the plan.
Covered % for the procedure category, if that is defined for the plan.
Default % entered for the plan.
To update settings for a plan:
Select Tables > Insurance > Plans. Use the Search field to select the plan. The data entry fields are displayed.
On the General tab, in the Coverage Information section:
Click New. Select a Procedure Category, enter the % for that category, and click Ok. The coverage information is displayed in the Procedure Category list.
Repeat to add categories/covered percentages to the list.
Enter a Default % for the plan. This is the covered percentage that is used when listed categories do not apply.
You must have at least a Default % listed for the plan, in order for insurance estimating to work.
Click the Fee/Benefits tab and select Fee Schedule and Allowable Schedule for this plan.
To update or copy an existing schedule to fit the plan, click Edit. For more information, see Setting Up Fee and Allowable Schedules.
Use the Auto W/D Code field to select a code for automatic write-offs and discounts, and enter an amount in the Auto W/D Amount field, if applicable.
Use the Estimation Method field to select the method for estimating insurance coverage for this plan. CLICK HERE for a description of each Insurance Estimation method.
Ensure that the applicable Plan Maximum and Deductible amounts are entered for the plan.
Click Ok.