You can access an insurance plan's coverage details, or Allowance Tables, from The Coverage column in the Insurance Plans List. (Administration > Insurance > Plans). These tables define the covered percentage or amount patient insurance is expected to pay for defined categories and procedures. This information is used to estimate patient and insurance due amounts, and is reflected in the Patient Ledger and Billing Statements.
Note: It is important to set up these tables correctly before entering charges. Updates to Allowance tables affect transactions going forward, but cannot correct past transactions.
Note: You can access the table for an individual plan by selecting View Allowance Table from the Update Insurance Plan window.
To add or edit coverage details for an insurance plan:
- From the Administration tab, select Insurance > Plans. The Insurance Plans list is displayed.
- Use the filters to refine the list as needed; click column headings to sort the list.
- In the Coverage column for each plan, select Add or View.
Note: If you click View, a Table Summary is displayed. You can then click Edit Allowance Table Details for this Plan to make changes.
The Plan Name - Allowance Table window is displayed.
- Under Actions, select Import Values. The Import Allowance Table Values window is displayed.
- In the Import From field, select Office Fee Schedule or Existing Allowance Table.
--For Office Fee Schedule, select a procedure list / fee schedule from the drop-down list.
Note: You can select any active procedure list / fee schedule. Procedure lists can be managed in the Procedure List and Fee schedule screen (Administration > Procedures & Fees > Procedure List & Fee Schedule). See How to Use Multiple Procedure Lists / Fee Schedules for more information.
--For Existing Allowance Table, select a Plan from the drop-down list, and then select to import All Coverage Rules or Only Allowed Amounts.
Note: Selecting All Coverage Rules imports rules such as whether a procedure is covered, whether it applies to a deductible, defined copayment or allowed amounts, the covered percentage, limitations, and so forth. Only allowed amounts are available when importing values from a procedure list / fee schedule.
- Select Overwrite All or Fill in Blanks.
Note: These options are only available if you are editing an existing allowance table. Selecting Overwrite All overwrites all existing values with the imported values, while Fill in Blanks takes the rules and values from the procedure list or allowance table and inserts them into the current allowance table wherever there is undefined information.
When you select Fill in Blanks:
-Values set to Yes under Covered or Applies to Ded do not revert to No.
-A $0.00 or 0% value can be updated, but a dollar or percentage amount value cannot be changed to a zero amount. This applies to all fees, allowed amounts, deductible and co-pay amounts, and covered percentages.
-Limitations can be added via importation, but existing limitations are not reverted to a None Defined status.
- Click Import Values. The Allowance Table is populated with the selected values.
Important: ALL procedures must have a fee associated with them before you import the table.
- You can manually adjust items in the allowance table as needed, and then click Save Changes.
To adjust all procedures on a plan:
- Under Actions, select Adjust all Procedures. The Adjust Coverage Rules window is displayed.
- Enter or select information in the fields:
Covered: Yes or No
Applies to Deductible: Yes or No
Copay Amount – Enter $.
Coverage Percentage – Enter %.
- Click Apply.
- Click Save Changes.