The Key to Accurate Insurance Estimates—Understanding How Fee Schedules Work in Dentrix

Once you understand the hierarchy of how Dentrix looks at fee schedules to calculate insurance estimates, you can improve the accuracy of your patient estimates. 

Sometimes I work with offices that are manually calculating patient estimates rather than using the estimates provided by the Dentrix Treatment Planner and the Ledger. If patient estimates appear off in your practice, it’s probably because insurance and benefit information isn’t being entered for the patient correctly in Dentrix.

It’s important to understand which information Dentrix looks at when calculating patient estimates, and how it prioritizes that information. Once you understand that, you can train your office staff to enter patient insurance information properly to achieve accurate patient estimates.

The first thing you should do is to make sure that fee schedules are assigned correctly in Dentrix.
There is an order Dentrix uses to determine which fee schedule should be used for a patient. It will look to the fee schedule in the Patient Information dialog box in the Family File first. If there is not a fee schedule assigned there, it will look to the fee schedule assigned in the Dental Insurance Plan Information dialog box next. If there is not a fee schedule entered in either of these places, Dentrix will use the fee schedule attached to the provider for the patient.

It’s important to understand how the fee schedule in each of these areas in Dentrix works in order for Dentrix to accurately calculate insurance estimates for a patient.

Patient Information

The first place Dentrix looks to determine which fee schedule to use for a patient is the Patient Information dialog box in the Family File. If the patient has dental insurance or will be charged your standard office fee schedule, I suggest that you leave this fee schedule set to <NONE>/<Prov Default>.

Only change this fee schedule if the patient has a discount plan or a membership plan with your office and you use a specific fee schedule for them.

Remember, Dentrix uses the fee schedule selected in the Patient Information dialog box first, and this fee schedule trumps a fee schedule assigned in either of the other two areas discussed below. That’s why if another fee schedule should be used instead, you need to set this fee schedule to /. This can become troublesome if, for example, the MetLife fee schedule is selected in the Patient Information dialog box because the patient used to have MetLife, but now they have changed insurance to Delta Dental. Even if the insurance was changed to Delta Dental in the Dental Insurance Plan Information dialog box, if the fee schedule was not changed in the Patient Information in the Family File, the patient will still be charged MetLife fees.

Dental Insurance Plan Information

The second place Dentrix looks for which fee schedule to use to calculate estimates is the Dental Insurance Plan Information dialog box.

When a patient has dental insurance, attach a fee schedule to the plan.

If your office is contracted with the insurance plan, you can assign your contracted fee schedule here, or if you are an out-of-network provider, you can assign your office fee schedule to the plan. Whichever fee schedule is assigned to the plan in the Dental Insurance Plan Information dialog box is the one that will be used for all patients covered on that insurance plan unless they have a Patient Information fee schedule assigned, as discussed above.

Provider Information

If a patient is not assigned to a fee schedule in the Family File, and they do not have dental insurance, Dentrix looks to the fee schedule assigned to the provider. You can assign a fee schedule to a provider in Practice Resource Setup in the Office Manager.

It’s important to assign your office fee schedule to providers. When you do this, if the patient is not on a discount or membership plan (and is not assigned a fee schedule in the Family File), and they do not have dental insurance (and therefore no dental insurance plan fee schedule is assigned) the patient will be charged your office fee schedule.

The first step to providing accurate patient estimates is to make sure that the fee schedule used to calculate those estimates is assigned in the right places in Dentrix.


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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 vectordentalconsulting@gmail.com.