Usually when PPO fees aren't calculating correctly it is because:
- the fee schedule is not assigned correctly (probably, it is incorrectly assigned to the plan instead of the carrier)
- the fee schedule is not the correct type (it should be an Ins-PPO type; not Ins-Smart Fee, Ins-Managed Care, or Ins-Smart Fee).
PPO fee schedules should be assigned to the carrier.
PPO fee schedules should be input as "Ins - PPO" type.
Let's do an audit of the plan and carrier that is not calculating the PPO fees correctly:
Click the word “Setup” and the “Fee Schedule” and "Fee Schedule Assignments" options from the drop-down list:
- Locate the fee schedule.
- Confirm the type is "Insurance - PPO."
- If not, click the Add New Schedule button to add the schedule as "Ins - PPO" type.
From the Patient Overview screen, confirm the PPO fee schedule is assigned to the Carrier:
- Click on the hyperlink for the Carrier name
- On the Dental Insurance Carrier Setup screen, ensure the PPO fee schedule is assigned to the carrier.
- If not, click the Edit button. Select the fee schedule, click the Save button.
From Patient Overview screen, confirm there is not a fee schedule attached to the Plan:
- Click on View Ins Plan
- Click on the Fees tab
- Confirm there is not a fee schedule assigned to the plan.
- If there is a schedule attached to the plan, this will create incorrect fee calculations. You should delete the attachment the word “Setup” and the “Fee Schedule” and "Fee Schedule Assignments" options from the drop-down list.
Once you have the PPO type fee schedule correctly assigned to all the necessary carrier listing(s) and have confirmed there is not a fee schedule assigned to the plan, the posted procedures should calculate the fees correctly.