Customers in the U.S. can enable settings to automatically update a patient's remaining deductible and benefits, as well as automatically setting the policy remaining deductible and benefits to the plan's defaults when the defined coverage period resets.
If enabled, these settings allow for more accurate insurance estimation and prevent you from having to manually update each patient's available coverage every year.
Note: To view a snapshot of a patient's Deductible Remaining and Benefits Remaining values, select Patient > Home and these values are included in the Insurance section.
To enable the insurance estimation defaults:
- From the Administration tab, select Practice Settings > Financial Rules.
- Click Edit Financial Rules.
- Navigate to the Insurance Estimation Defaults section. Click Yes next to each setting you want to enable.
- Click Save.
The available options include:
- Auto Reset Based on Coverage Period
- Auto Update Deductible Remaining
- Auto Update Benefits Remaining
Auto Reset Based on Coverage Period
The available insurance coverage (Deductible Remaining and Benefits Remaining) for every patient in the practice will automatically reset based on their insurance plan's defined annual coverage period.
Note: See How to Add or Update Patient Insurance for more information on defining fee coverage information for an insurance plan.
Auto Update Deductible Remaining
A patient's Deductible Remaining will automatically update when billable charges are posted and claims are created for procedures that apply to the deductible.
When a new charge is posted to a patient's account and a claim is created for an active dental insurance policy, the patient's Deductible Remaining value will decrease by the deductible amount included on the estimation for each charge.
Note: When you post a charge, you can click on the Total (Pt Due) amount to see the Insurance Estimation Details for each charge.
Note: The system does not auto-adjust for corrected or removed charges. When charges are corrected or removed (which necessitates that any associated claim is cancelled), or if a claim is cancelled, any previously automated reduction to the deductible remaining is not automatically adjusted, and a message is displayed informing you that the adjustment or removal may have impacted the patient's calculated Deductible Remaining value, Benefits Remaining value, or both.
Auto Update Benefits Remaining
A patient's Benefits Remaining will be automatically updated when insurance payments are posted for the associated insurance policy. When insurance payments are posted for an insurance claim, the patient's Benefits Remaining value decreases by the amount of the insurance payment posted for the associated plan.
Note: The system does not auto-adjust for corrected or removed payments. When you adjust or remove an insurance payment, a message is displayed informing you that the adjustment or removal may have impacted the patient's calculated Deductible Remaining value, Benefits Remaining value, or both. In this case, you can manually confirm and, if necessary, update these values.
To manually update a patient's Benefits Remaining or Deductible Remaining amount:
- From the patient's home page (Patient > Home), click Update Insurance.
- From the Insurance Information section, click Edit next to the insurance policy. The Update Insurance Policy window is displayed.
- Enter a value in the Benefits Remaining or Deductible Remaining fields, and then click Update.
Note: Any manual adjustments to the policy deductible or benefits remaining values will set a new threshold to use for any automated updates.
See How to Add or Update Patient Insurance for more information.
If you update the Deductible and Maximum Allowable Benefit amounts for an insurance plan (Administration > Insurance > Plans > Plan Name), this change will apply to every patient that subscribes to the plan.
Note: See How to Add or Edit Coverage Details for an Insurance Plan for more information.
If you update the amounts before the insurance plan's defined coverage period ends, a message is displayed asking you to confirm how you want to apply the new annual plan limits.