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How can we create and assign a fee schedule for a provider with specific fees that does not participate in Insurance when we have Carriers with office specific assignments?

Robin Moone (She/Her)
Updated

Introduction:
This guide is intended for providers who collect their full fees from patients and cannot participate in insurance plans for collection. This could be for a specialty provider, a temporary (temp) provider, a provider who will not be added to insurance contracts for the practice, or a provider with specialty fees who cannot bill to insurance. Whatever your case, this guide is for specific providers with fees that must be collected fully from a patient without insurance participation.

Process description:
Add a new DXXXXABC alternative code for each code desired where DXXXX is the ADA code you wish to use and ABC is an alphanumeric entry unique to the provider's code. Make the code a "Do not bill to insurance" procedure and set your desired provider as the default provider. Create a new fee schedule with Office as the Type and be sure to enter fees only in the Patient Column. The fee schedule, once named and saved, can then be assigned to that specific provider. Following the completion of the assignment, if the provider has procedures assigned to them, these will be the fees that are populated.

Prerequisites:
You will need the following security rights attached to your user account's Group Membership:

  • Setup - Procedure Codes Screen Full Control
  • Setup - Fee Schedule Assignments (Bulk) Screen Full Control
  • Setup - Fee Schedules Assignments - (New) Screen Full Control and/or Setup - Fee Schedules Assignments Screen Full Control
  • Setup - Fee Schedules Screen Full Control

You will need to have the provider already added into Denticon under Setup > Providers > Provider Setup.

Gathering materials/resources:
Be sure to have a list of all the procedures the provider will provide so all procedures can be setup and added to the system correctly.

Step-by-step instructions:

  1. Adding Alternative Codes
    1. Go to the menu for Setup > Procedure Codes > Procedure Codes
    2. Press Add New Code
    3. Be sure to make the following changes:
      1. Description = A unique Procedure Code name to show that this code belongs with this provider and which treatment the code is for
      2. Code = DXXXXABC where DXXXX is the ADA code you wish to use and ABC is an alphanumeric entry unique to the provider's code. (Ex. D1110X, D0120AB, D1230DRC)
      3. Insurance Billing Order = Do not bill to Insurance
      4. Default Provider = Your Provider's name
      5. (Optional but Strongly Suggested) Lock Default Provider = Yes
    4. Press Save to confirm the details and repeat for each code as needed.
  2. Creating the Fee Schedule
    1. Go to the menu for Setup > Fee Schedules > Fee Schedule Setup
    2. Press Add New Fee Schedule
    3. Be sure to make the following changes:
      1. Name = A title that will be easy to remember for the provider. Be sure it is obvious to your team.
      2. Fee Schedule Type = Office
      3. Fee(s) = For each new code, enter the desired fees for the provider's new codes.
    4. Press Save to confirm.
  3. Assigning the Fee Schedule
    1. Go to the menu for Setup > Fee Schedules > Fee Schedule Assignment
    2. Check for any pre-existing fee assignments with solely a provider and a fee schedule populated. Delete them as needed using the red trash can icon.
    3. Press Add New Fee Schedule
    4. Be sure to making the following changes:
      1. In the top left, select the new fee schedule containing all the new procedure codes by clicking the corresponding bubble.
      2. In the bottom right, select the bubble that says "Select Provider/s" and select the provider you setup your changes for.
    5. Press Assign Fee Schedules then OK to confirm.
  4. Visual Guide

Tips and best practices:
Be sure to let your team know that the provider needs their procedures added to Treatment Plans and Ledgers using only these codes.

Next steps:
Test the codes by adding them to the patient's Treatment Plans before posting. Make sure that the fees populate as expected.

Additional information:
How do I add a fee schedule?

How do I add a procedure code?

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