An insurance payment table is a list of procedures and the amounts a payer pays for each procedure. You can add, edit, and remove procedures, and the fee listed in the payment table will override the coverage percentage in the coverage table for the same procedure.
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Setting up an insurance plan’s payment table
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Enable or Disable payment tables
To set up an insurance plan’s payment table, do the following:
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On the Home menu, select Carriers.
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Click a carrier to view the associated insurance plans.
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Click an insurance plan to view the plan’s options.
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Click Payment Table.
The Payment Table dialog box appears.
Note: Initially, the plan's payment table is empty.
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To add procedures, do the following:
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Click Add Procedure to add a line item at the top of the list.
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In the Search box, begin typing part of a procedure code or description, and then select the correct procedure.
The Amount box is selected automatically.
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Enter the amount that the payer pays for the selected procedure.
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Repeat steps a-c as needed to add other procedures.
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Click Save.
Note: As you add procedures, they are inserted before any existing procedures in the list. However, when you save the changes and then reopen the dialog box, the procedures are sorted by code.
Over time, the list will become long, but you can filter to list to show only procedures that match search criteria that you enter in the Search by code/description box located above the list.
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To remove a procedure, click the corresponding X.
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To edit a procedure's amount, click (or tap) in the corresponding Amount box, and then enter a new value.
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Users can enable or disable payment tables to respectively allow or prevent the amounts entered for procedures in payment tables to override coverage tables percentages. To allow payment tables to be used for calculating insurance estimates in your organization, you must turn on a new setting.
To enable or disable payment tables, do the following:
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On the Settings menu, select Ledger Options to open the Ledger Options page.
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Select the Ledger Rules tab.
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Set the Payment Table amounts should supersede coverage tables switch to Yes.
Note:
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If the option is set to No, payment tables do not affect estimates, and a message appears in the payment tables of insurance plans (go to Home > Carriers, select a carrier, select a plan, and click Payment Table) to indicate that.
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If the option is set to Yes, payment tables can affect estimates:
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If there is an override at the procedure level, that amount is used as the insurance portion instead of the amount in the payment table.
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If the procedure exists in the payment table, that amount is used as the insurance portion.
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The write-off for the remaining amount is based on the coverage table.
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Whether or not payment tables are used, the insurance portion cannot exceed the procedure amount, the patient portion is equal to the procedure amount minus the sum of the insurance portion and the write-off amount, and estimates take used benefits and deductibles into account.
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Click Save.
Note:
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Viewing the ledger options, including the payment table setting, requires the existing “Review ledger options” security right.
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Enabling/disabling payment tables requires the existing “Manage ledger options” security right.
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Estimates appear in the following areas of Ascend Academic:
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Calendar – Scheduled net (appointment, day, totals).
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Ledgers.
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Statements.
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Treatment plans.
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Estimate details.
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When you are viewing estimate details, if a payment table is in use for a procedure, that procedure’s amount is orange, and if you click the amount, a Payment Table In Use pop-up message appears for your reference.
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