Insurance Coverage

Thursday, September 3rd, 2009

Insurance Coverage Changes

by Flo Janes

If you have ever had an insurance claim rejected due to the relationship not matching the carrier records, we have an easy fix for you!

You don’t have to start from scratch if you have accidentally posted a patient’s relationship as “self” and need to change it to “spouse, ” or if you have posted incorrect information on the coverage change and need to updateit. All you have to do is override the information on the existing coverage.

When you are updating coverage, hit the Search Key (F6) on the date field, find the coverage change date that you want to override, and SELECT. Go to the section that you want to change and enter the correct information.
Hit ESC/EXIT and post this to the patient’s ledger. This will override the old entry and replace it with the corrected information.

When billing an insurance form, the current coverage is used as the default coverage for billing purposes. If you want to bill procedures from a previous coverage period, all you have to do is hit the Search Key (F6) before you choose the carrier, then type in the date of service or the date the coverage began for that transaction. The system will then pull the insurance information that was active for that date.

You DO NOT want to search to find the last coverage date if you are making a new coverage update. This is only for editing existing coverage. However, searching will show you their existing coverage so you will know when to start your new coverage. We do not recommend using the first of the year unless your patient is seen on or around that date. Coverage dates should be the first billable visit date of new transactions, not when the patient’s coverage began.

You don’t want to back date coverage to prior years unless it is truly needed for billing purposes. Often times we see patients whose first visit was in 2009, yet their coverage change was posted as 1998 (their start date of coverage). You don’t need to use the date their coverage began, only the date that will be their first billable service.

Insurance Fee Schedule

Monday, July 13th, 2009

Insurance Fee Schedule

By Laura Andersen

Datacon has the ability to use an insurance fee schedule to calculate estimated insurance portions on fees, while posting UCR fees. This is done by setting up an Indemnity insurance plan through Employers and Insurance Plans and then connecting your patient to it with a coverage update.

The plan requires the fee schedule to be set up with plan fees and the plan type set as Indemnity. Once set up and connected to the patient, all treatments entered through Diagnosis Records or Charges will estimate off the plan fees while the fee showing on the transaction will be your standard UCR fee. This modified estimate will show on the treatment plan screen as well as on your printed treatment plan documents.

If you use an “insurance and patient estimates” note on your statements or route slips, these estimates will also be figured from your plan fees, increasing or decreasing the patient portions for the difference.
If you need help setting up a new insurance plan, call our Support Department and we will walk you through it.