First, you must set up the procedure code and fee schedule so the proper fees will be reported in the patient treatment plan. Please consult the question in the Fee Schedule section that provides guidance on the set up of alternate minimum benefits codes and fees. There are two questions at Help / Help Portal / Fee Schedule / Alternate minimum benefits (AMB) amounts – (1) alternate minimum benefits (AMB) amounts, and (2) procedures for alternate minimum benefits).
Access a patient’s Treatment Plan screen in one of two ways –
1) Click the word “Transactions” and choose the “Treatment Plan” option from the drop-down box
2) Click the Treatment Plan Entry icon in the picture toolbar
Enter the desired treatment procedure codes:
- For a plan that the standard ADA code may be used, enter the standard ADA code.
- For a plan that the office wishes to report on the Treatment Plan as the AMB pricing, select the AMB code; that is, the code that indicates the sub-letter after the standard ADA code.
The pricing for the procedure will indicate:
- Full fee for the procedure per the applicable fee schedule
- Estimated insurance portion based on the percentage coverage for the procedure, calculated from the amount charged for the downgraded procedure code
- Estimated patient portion to reflect the difference between the full fee and the estimated insurance portion.
NOTE: "D" must be input before the procedure code number in the AMB column or the AMB code will not calculate. The fee for the procedure code in the treatment plan will reflect the fee schedule, but the patient's Est Ins column will update to reflect the AMB coverage.
In the below example, the plan is set to cover restorative procedures at 80%. The fee for D2391 on the example schedule is $50, so we would expect the Est. Ins portion to be $40 normally. However, we have an AMB code to downgrade to D2140. The fee for D2140 is $20 so if the AMB code is calculating correctly, we would expect to see coverage of $16.