An updated payment table helps ensure accurate estimates, and helps you collect patient portions at the time of service.
The payment table in Dentrix is a great tool for you to use to track what insurance companies actually pay for procedures. You can open the Dental Insurance Benefits and Coverage window for a patient and click the Payment Table & Allowed Amounts tab to enter a procedure code and the corresponding dollar amount paid by an insurance company for that procedure code.
Dentrix will then use this information for all patients covered under this same insurance group plan.
I like using the payment table to track downgrades. For example, you might file a claim for a posterior composite filling, but instead of paying 80% of the composite filling fee, the insurance company downgrades the procedure and pays 80% of the fee for an amalgam filling. By entering the procedure code and the dollar amount actually paid into the payment table, Dentrix would then calculate the downgraded amount into estimates when that procedure code is used again for any patient covered under that insurance group plan.
The payment table is also very helpful if your office is out of network with an insurance plan. So instead of paying 100% of your office fee for a prophy and exam, the insurance pays 100% of their allowable amount for those procedure codes. Once this information has been entered into the Payment Table, the patient’s portion of the procedures would be calculated accurately.
Procedure codes and payment amounts can be entered into the payment table through the Dental Insurance Benefits and Coverage window from the Family File or Office Manager. This is a good way to enter data into the payment table if the insurance company has provided you with payment amounts, such as when you verified a patient’s benefits and they informed you what their allowable amount is for a prophy and exam.
Another way you can update the payment table is while you are posting insurance payments. It’s easy to update the payment table by simply clicking Yes, and you can do it all without having to go into another area of Dentrix.
I like updating the payment table while posting insurance payments because I can look at the explanation of benefits and determine if I want to update the Payment Table for that insurance group plan based on why the insurance paid the way they did.
There are situations when posting an insurance payment when I do not suggest updating the payment table. Don’t update the payment table if a procedure wasn’t paid as expected due to:
- The patient met their insurance maximum.
- A deductible was applied to the procedure.
- A procedure wasn’t covered due to an age limitation.
- A procedure wasn’t covered due to a frequency limitation.
Additionally, when updating the payment table, consider if you want this payment amount to be applied to all patients covered under the group plan.
If you have updated the Payment Table for a procedure, be aware that as you present treatment estimates to other patients covered under the same insurance plan, you may need to have a conversation with them about downgrades and allowable amounts. This helps patients understand why their insurance plan isn’t paying 80% of posterior composites or 100% of a prophy and exam since your office is out of network.
It might be a good idea to add a treatment case note to your treatment plans stating that estimates from insurance companies cannot be guaranteed and the insurance may downgrade procedures based on the patient’s coverage.
When entering paid amounts into the payment table in Dentrix, you can provide your patients with more accurate estimates and collect patient’s portions at the time of service and avoid patient balances after treatment has been completed.
Learn More
For additional information, read the following :
- An Easier Way to Manage Patient Insurance Details
- Improve Insurance Payment Estimates with Coverage Tables and Payment Tables
- Improve the Accuracy of Patient Fee Estimates
By Charlotte Skaggs
Certified Dentrix Trainer and The Dentrix Office Manager columnist
Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for over 20 years and is a certified Dentrix trainer. Contact Charlotte at [email protected].
