Managing Insurance Payment Adjustments

Dentrix makes it easy to post write-off and refund adjustments when you receive insurance payments. 

Imagine this scenario: Brent Crosby came to your office a few weeks ago for a filling. You completed his treatment and submitted a claim for a resin one-surface with a $115 charge. When you received the check from the insurance company, it was only for $100 and included a letter that explained that $100 was the usual, customary, and reasonable fee (UCR fee) for that procedure.

If your practice accepts dental insurance, this has no doubt happened to you. UCR fees are the maximum amount insurance companies will pay for certain procedures, so regardless of your practice’s fee for the procedure, you won’t get more than the UCR fee from the insurance company. These fees can vary by procedure and by insurance company, so it can be hard to anticipate what the UCR fee will be.

Oftentimes you don’t know about an insurance company’s UCR fee until you submit a claim and receive a payment that is less than what you charged on the claim. What do you do in that situation? Most often you just have to write off the difference. Luckily, Dentrix makes it easy to post a write-off adjustment to insurance claim payments.

Entering Write-off Adjustments

To enter a write-off adjustment when you post a payment to a claim, from the Ledger, select the patient and open the insurance claim for which you want to enter a payment. In the insurance claim, from the Enter Payment menu, select Total Payment Only. The Total Insurance Payment dialog box appears.

Enter the payment information, such as the date, check number, bank/ branch number, and type of payment. Under Provider Amounts, select the provider to whom you want to apply the payment. Click Edit to enter the claim total, or click Add to add a payment for a new provider. Under Enter Adjustment, select Write-off (-) from the list.

Enter the dollar amount you want to write off for the claim. In Brent’s case, the write-off amount would be $15. From the Type list, select the adjustment type you want to use. Click OK to post the write-off.

If you want to track write-offs by insurance company, you can set up a specific write-off type for each insurance company. That way, when you run the Adjustment Summary from the Practice Analysis in the Office Manager, you can track how much you are writing off for each insurance company.

Entering Refund Adjustments

In some cases patients will have paid their estimated balance before you receive the insurance payment, and the insurance payment may have covered more than you expected, so you need to enter a refund adjustment for the patient. You can also enter refund adjustments when you post a payment to a claim.

To enter refund adjustments on the insurance payment, follow the previous steps to enter a write-off adjustment. You just have to select Refund from the Enter Adjustment list instead of Write-off .

Entering insurance adjustments from the Total Insurance Payment dialog box in the insurance claim saves you from having to enter the insurance payment and then enter a separate adjustment. It also makes it easier for you to calculate the amount that needs to be adjusted, so it makes it easier to work with insurance payments.

Specifying Default Adjustment Types

You can make entering adjustments even easier by specifying default adjustment types for write-offs and refunds. Then, when you split the claim and are left with a write-off or refund adjustment, you don’t have to select the adjustment type; the type you use most often will already be selected for you.

To specify the default write-off and refund insurance adjustment types, in the Ledger, from the File menu, click Insurance Payment Setup. The Insurance Payment Setup dialog box appears.

Under Insurance Adjustment Setup, click the search buttons to open the Select Adjustment Type dialog box and select the default insurance write-off and refund adjustment types.

If you want to have Dentrix automatically calculate adjustments when you enter insurance payments and save you the step of manually calculating the adjustment amount, check the Enable Automatic Adjustments for Insurance Payments check box. If you want Dentrix to automatically post adjustments to replace negative payment amounts when the insurance company overpays, check the Auto-post Refund adjustments to replace negative payments check box. Click OK to save the default adjustment types.


Learn More

Attend a Dentrix Seminar or Workshop to get more information about insurance management. Visit https://www.dentrix.com/training/workshops or https://www.dentrix.com/training/insight-seminar for a list of available courses.

To learn more about adjustments in Dentrix, see Adjusting Insurance Payments Automatically and Setting Up Automatic Insurance Payment Adjustments in the Dentrix Help.


By Erin Brisk, Senior Editor

Originally published in Dentrix Magazine, Fall 2011