There is more to managing your insurance plans than simply entering plan information into Dentrix. Learn about the ongoing maintenance you should do to keep things running smoothly.
I couldn’t wait until I turned 16. My older brother had gone away to college and left his car for me to drive. I had big plans for that Datsun B-210. But soon after I was handed the keys, my big plans suddenly took an unexpected turn. I had planned on spending money to fill it up with gas, but didn’t realize there was a lot more money, time, and effort that went into the maintenance of the car. I hadn’t planned on having to pay for oil changes, tire rotations, the occasional carwash, or unexpected expenses from accidents or breakdowns. When I made the mistake of complaining about these added expenses to my parents, I was told that this was all part of being a car owner.
Similarly, there is more to managing your insurance plans than simply entering plan information into Dentrix. There are ongoing types of maintenance you should do periodically to keep things running smoothly. From time to time you should purge your database of insurance carriers you either no longer accept or that are no longer attached to any patients in your system, join or remove duplicate insurance plans that may have been entered by mistake by different staff members, reset insurance benefits used, and update coverage tables and payment tables.
Purging Insurance Plans
It is vital to have the most updated and accurate insurance plan information stored within Dentrix. In order to keep your database running smoothly, you should purge your database of insurance plans you no longer accept and insurance companies within your database that are no longer attached to patients.
As a safeguard, Dentrix only allows you to purge insurance plans that don’t have subscribers attached, and only after all claims for the plan have been received. Only those insurance plans that meet these criteria appear in the Purge Dental Insurance Plans dialog box.
For example, let’s say that your practice no longer accepts the BlueCare DHMO insurance plan, and you want to delete it from your database. From the Maintenance menu in the Office Manager, click Reference > Insurance Maintenance. The Insurance Maintenance dialog box appears.
At the bottom of this dialog box, click the Purge button, which will open the Purge Dental Insurance Plans dialog box.
A list appears showing all insurance plans that are not attached to subscribers and for which there are no outstanding claims. You can select the individual plan from this list you want to delete, and then click the Delete button, or to delete all plans visible in this list, you can select Delete All.
If the insurance plan you want to delete does not appear on the list, a patient or outstanding claim is still attached to it. You must clear the plan from the patient’s Family File before you can delete it. To find the patient to which the plan is still attached, print the Insurance Carrier List for that plan. For more information about generating this list, see the Removing Duplicate Insurance Plans from Dentrix section below.
Joining Insurance Plans
Another essential part of insurance maintenance is making sure that you aren’t cluttering up your insurance carrier database with multiple, identical plans. Oftentimes your database can have multiple instances of the exact same plan due to different staff entering in information, spelling mistakes, various abbreviations, or simply not checking to see if a plan is already in the system before adding it.
The Join Insurance Carriers utility allows you to quickly move all subscribers from a source insurance plan to a desti – nation plan and merge two insurance plans into one. You can use this utility to move subscribers from a duplicate insurance plan and combine all subscribers into the same group.
As a safeguard, Dentrix only allows you to join insurance plans when all Dentrix modules are closed. After closing all modules, open the Office Manager on a single computer to make the necessary changes.
For example, you notice that your Insurance Maintenance list contains an Aetna plan with a group name of JC Penny and another Aetna plan with a group name of J.C. Penney. Upon closer inspection of each plan, you can see that they are in fact the same plan, but each was entered with an alternate spelling. You want to combine both plans into the J.C. Penney group, which is spelled correctly.
To join these insurance plans, first close all open Dentrix modules on all computers in the network. Then open the Office Manager on one computer, and from the Maintenance menu select Reference > Insurance Maintenance. When the Insurance Maintenance dialog box appears, click the Join Plans button at the bottom of the window. The Join Insurance Plans dialog box appears.
In this dialog box, select the way you want to join the plans:
- Employer-based–Moves all subscribers attached to an insurance plan linked to a specific employer to another insurance plan that is linked to the same employer. Note: When selecting Source Insurance Plans and Destination Insurance plans (see steps below), plans will be limited to those sharing the same employer.
- Plan-to-Plan–Joins insurance plans, regardless of employers.
- Subscriber’s employer must match Insurance Plan Employer field (optional)–Moves only subscribers who are assigned the same employer in the Family File.
Then, click the Source Insurance Plan search button, and in the Select Dental Insurance Plan dialog box, select the insurance plan that you want to join with the destination insurance plan and click OK. Do the same with the Destination Insurance Plan search button and in the Select Dental Insurance Plan dialog box, select the insurance plan that you want to join the source insurance plan with and click OK. Be sure to heed the warning that appears at the bottom of the dialog box before clicking the Join button. After you click Join, a message appears.
To move all subscribers from the source insurance plan to the destination insurance plan, click Yes. A confirmation message appears at the completion of the merge or if no subscribers matching the criteria associated with the source insurance plan exist.
Removing Duplicate Insurance Plans from Dentrix
Often, insurance carriers and plans are inadvertently entered into the system multiple times. This can cause confusion and problems when entering batch insurance payments or updating coverage tables, payment tables, and other insurance information.
There is a way to remedy a situation in which there are duplicate insurance plans that have been entered. First, join the insurance plans (following the steps in the section above), and then purge the duplicate plan that no longer contains any patient information.
For example, let’s say you have discovered that you have duplicate versions of the Ameritas insurance plan for employees of American Express. You want to move all subscribers into one American Express group plan, and then purge the remaining duplicate plans.
First, generate the Insurance Carrier List and include subscribers. From the Office Manager, click Reports > Reference > Insurance Carrier List and select the desired insurance group range. In the Select List Types group box, uncheck Standard List, check Include Subscribers, and click OK. The list is sent to the Office Manager’s Batch Processor, where it can be previewed and/or printed.
Use the Insurance Carrier List to find a subscriber who is assigned the correct version of the group plan. Select that subscriber in the Family File and double-click the Insurance Block. The Insurance Information dialog box appears, showing the insurance carrier name. Click the Insurance Data button. Since this is the insurance plan you will be keeping, make any corrections to the carrier information and mark the group plan name with an asterisk (*) so that you will be able to identify it from the other duplicates, and click OK. From the pop-up box that appears, select the Change Plan for All option and click OK.
Note: Duplicate plans can look exactly the same, so by marking the plan you want to keep with an asterisk, you’ll know which of the duplicate plans you are keeping, and which one(s) you can remove.
Now that you have designated the plan you want to keep, join the duplicate plans using steps from the Joining Insurance Plans section above. You can then delete the plan(s) that no longer have subscribers attached using the steps from the Purging Insurance Plans section above.
Once all duplicate plans have either been joined or purged, return to the Insurance Information dialog box, and click the Insurance Data button. Remove the asterisk from the Carrier Name field, and click OK.
By removing duplicate insurance plans, you will avoid the likelihood of data-entry mistakes because you selected the wrong insurance plan.
Resetting Insurance Benefits Used
Another task in managing your insurance plans is resetting insurance benefits used. Most insurance plans are based on 12-month periods. While most insurance benefits expire at the end of each calendar year, individual insurance plans may have a different month in which their benefits reset. It’s important to set the plan expiration date properly in Dentrix so that when the benefits reset for that plan you can reset the benefits and deductibles for patients on the plan.
For example, you discover that the Blue Cross Blue Shield insurance plan used by the AT&T employer resets benefits in August, but that information was not entered into Dentrix at the time the other insurance information was.
To edit the insurance plan information, from the Office Manager, select Maintenance > Reference > Insurance Maintenance, and select the insurance plan to be edited. Then click the Ins Data button at the bottom of the dialog box. Find the field for Benefit Renewal, and select the renewal month from the dropdown list.
Click OK to save your changes.
To purge the benefits used for this plan, from the Office Manager, select Maintenance > Reference > Purge Dental Insurance Benefits Used. From the Purge Dental Insurance Benefits Used dialog box, select one of the following, and then click OK:
- Insurance Plans with Renewal Month of–To purge the benefits of all insurance plans that renew on the month that you select.
- Selected Insurance Plan–To purge the benefits of a single insurance plan. Click the search button to select the plan that you want to purge.
Note: When benefits are reset, no matter which month is reset, the benefits used and deductible will be reset to zero. If you are resetting benefits for a previous month, you may need to run a utility to recalculate your insurance benefit totals. You should contact Dentrix Customer Support for assistance in running this utility.
Updating Coverage Tables
One of the first things you do when entering a new insurance plan into Dentrix is enter coverage table information. A coverage table can include a schedule of benefits declaring the maximum annual benefits for individuals as well as benefits for the entire family. Coverage tables can also include deductible amounts, plan maximums, and the percentage of the “usual and customary fee” that the insurance company will pay. Entering this information into the insurance plan’s coverage table will help you have more accurate insurance estimates for claims.
Once you enter this information, you’ll want to maintain the coverage table with any new or updated information that becomes available. As you receive new coverage information or changes to plan benefits, you should enter that information into the coverage table. You can access the coverage table information from the Office Manager > Maintenance > Reference > Insurance Maintenance > Cov Table. When you are done making changes, make sure to select how you want to apply the changes to the plan. Select the option to Change Plan for All if you want to apply the changes to all other subscribers who have the same insurance plan. Select the Add as New Plan option if you want to copy all of the insurance information for the current subscriber and add the changed insurance plan without changing the original plan.
Updating Payment Tables
The payment table keeps track of past insurance payments on a per procedure basis. It then uses that information to more accurately predict what the insurance plan will pay for that procedure in the future. Part of an active and accurate collections process should be routine, correct, and comprehensive updating of payment tables.
A payment table is created for each new insurance plan entered into Dentrix. The payment table collects insurance payment information when you enter payments on a claim (by clicking the Enter Payment menu on a claim and selecting Itemize by Procedure) and then uses that information to override the information entered in the coverage table. To make sure that your patient portion estimates are accurate, you should be posting insurance payments using the Itemize by Procedure option.
As you itemize payments in the Insurance Coverage Update dialog box, you’ll enter the procedure’s payment amount if it’s different from the Dentrix estimate that automatically appeared. To save the paid amount as a reference for future estimates, click Yes under Update Payment Table.
Note: When you itemize estimates or payments, it is important that you only update the payment table when the payment amount applies to all patients covered by that plan. For example, if the estimated insurance portion is different from the payment amount because money is being withheld toward a deductible, do not update the payment table. Similarly, if a patient has exceeded his or her maximum benefits, or if payment is reduced because of a missing tooth clause or time limitations, do not update the payment table.
For more information about updating the payment table, see Posting Insurance Payments in the Dentrix Help.
Just as keeping your car running requires certain ongoing maintenance on the part of the car owner, so does maintaining your insurance plans in Dentrix. For a database that runs smoother, it is vital to plan time in your work schedule for periodic maintenance of your insurance plans.
To learn more about purging insurance plans, see the Deleting Insurance Carriers topic in Dentrix Help.
To learn more about joining insurance plans, see the Joining Insurance Carriers topic in Dentrix Help.
To learn more about how to reset insurance benefits used, see the Purging Dental insurance Benefits Used topic in Dentrix Help.
To learn more about coverage tables, see the Creating Coverage Tables and Editing Coverage Table Categories topics in Dentrix Help.
To learn more about payment tables, see the Adding Procedures to Payment Tables, and Editing Insurance Payment Tables topics in Dentrix Help.
By Sean Eyring, Contributing Editor
Originally published in Dentrix Magazine, Fall 2012