How Andre Sets Up In-Network Preventive Only or Limited Coverage Plan In Eaglesoft
There are many In-Network Employer/Coverage Plans that have limited policy that only covered preventative, diagnostic, and basic and there are states that allow an In-Network practice to charge the Patient the Standard Fee (“full fee”) for those Service Codes that are not part of those “limited plans”.
In this scenario, my suggestion is to create a Fee Schedule that ONLY includes the Service Codes that are covered in the plan detail. This leaves the non-covered services without a Maximum Allowable Fees and then the co-insurance (“patient portion”) is based on a Standard Fee and not an adjusted fee.
The easiest way to accomplish this is to go to Lists>Fee Schedule List and click New. In the next window select Utilize an Existing Fee Schedule. In the new drop-down choices, find the full In-Network Fee Schedule for this limited plan.
Next, name it like the Fee Schedule use but adding a phrase like “Limited”. You will then need to delete all the Service Codes that are NOT covered by this plan.
Click OK to save the final version of the “limited” version of this Fee Schedule.
Next, attach that new Fee Schedule to the Employer/Coverage Plan(s) that will use this Fee Schedule.
Do a few “mock” walkouts to test the co-insurance estimations.
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog.
