Creating a Coverage Table for Fixed Copays

Does your practice accept any DHMO or fixed copay fee schedules? If so, you may have wondered how to set up these plans to ensure you present accurate fees and co-pays to your patients. Here are the instructions to set up fixed copay plans.

Important: The Co-pay $ amount in the coverage table is not used to calculate the insurance and patient portions on the treatment planner or the patient ledger. It is for information only.

To create a coverage table for fixed co-pays

1. Determine the numbers. Obtain a copy of your insurance contracted fee schedule and the fixed copays by procedure code.

2. Open Excel and set up a calculator.

   1. In the first row, enter the fee.

   2. In the second row, enter the copay amount.

   3. In the third row, create a calculation for the coverage percentage.

   4. Add labels next your data entry places to help you keep track of what goes where.

      It might look something like this:

      

   Important: The key calculation is to convert the copay percentage into the coverage percentage, which is done like this:

   

   5. ClickTap the Excel Percent Style button to make the calculated value display as a percentage, and click the Increase Decimal button until you get three values to the right of the decimal point.

      

3. If this is your first time configuring a coverage table this way, start with a template.

   1. On the Coverage Table Setup page, select an existing template or click the New Coverage Table button to create a new empty table.

   2. Name the template.

   3. Add your procedure code configurations.

      Note: You can add procedure code ranges, or you can use the same code as the beginning and ending of the range to make the coverage specific to that code.

      1. Name the category or procedure

      2. Set the Deductible Type drop-down list to None.

      3. In the Coverage field, enter the coverage percentage up to three decimal places.

         

      4. ClickTap Add Range.

      5. Repeat the steps to add ranges for all the procedures you are likely to submit to an insurance carrier, based on what you do in your organization.

4. Apply your template to a specific insurance plan.

   1. From the Home menu, under Insurance, select Carriers.

   2. ClickTap a carrier name, then clicktap to select an existing plan or add a new one.

   3. In the plan editor, click Coverage Table.

   4. From the Select coverage table template drop-down list, select the name of your fixed copay template to load the configuration.

      

   Tips:

   • For any procedures that does not have a copay, set the coverage to 100%.

   • You can edit an existing coverage table if you don't need to create an entirely new one.

   • Import your template as a starting point for any plan. You can modify individual ranges as needed.

   • To learn more, see Editing coverage tables.