Overview
The main function of coverage tables is to provide a more accurate division of the patient and insurance portions of transactions. It is based on the premise that similar procedures are reimbursed at the same percentage rate by the majority of carriers.
Because a carrier doesn't normally pay the same percentage for every type of procedure, it is essential that procedures be divided into code categories to assign the proper percentage to each category.
A common example of the variation is the difference in percentages paid for office visits and those paid for crown and bridge work. Normally, office visits are paid at 100%, while crown and bridge work is covered at 50%. To handle this difference, enter the range of office codes and create a category called Office Visits. Then enter the range of codes that covers crown and bridge work and create a category Crown and Bridge Work. Office visits are put in the category Office Visits (paid at 100%) and crown and bridge work is put in the category Crown and Bridge Work (paid at 50%). When a service code is created, assign the appropriate category.
These categories are used in calculating estimated responsibility and allowed amounts.
Quick Steps
1.
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Click Setup in the toolbar.
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2.
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Locate the Accounting Setup section and click Set up default coverage tables.
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3.
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Click New Coverage Defaults or press F8.
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4.
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Create your own code (up to five characters or letters) or skip this field and let the program create a unique code for you based on the first three letters of the description and a few digits.
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6.
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In the Begin Range field of the first record, select or enter the first code (in alphanumerical order) of the range that fits the category you are creating.
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7.
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In the End Range field, enter or select the last code that fits in the category.
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8.
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Type the name of the category, such as Diag/Prev.
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9.
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Enter the coverage percentage (don't use the percentage sign, just the numbers).
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10.
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If any co-pay is required for this range of codes, enter the amount of co-pay required.
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11.
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Select the type of deduction by tabbing from the Co-Pay field and clicking the down arrow. Choose from Standard, Preventive, or Other.
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12.
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Tab to create the next record. If you want to insert a record in the midst of already created categories, clicking Insert Coverage Line inserts a new line above the record currently highlighted.
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13.
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If another plan has a similar set of coverage percentages, you can load that information here. Click Load from Insurance and double-click the similar plan in the Insurance Plan List screen. The default coverages associated with that carrier are copied in your new Default Coverage Entry screen. Make whatever adjustments are necessary.
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14.
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Click Save Changes or press F3.
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Once created, the default coverage table can be added to the Insurance Plan screen, Coverage tab.
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