Open Dental has some capability to automatically track out of network (allowed) fee schedules. We call this feature Blue Book. In other software, this is also known as coverage tables or payment tables.
To turn on this automation, in Family Module Preferences check Use Blue Book. This is what will happen:
- For each carrier associated with an out of network (Category Percentage) plan type, an out of network fee schedule (named by carrier, Use Global Fees checked) is automatically created. There are no changes to PPO plans.
- The new out of network fee schedule is attached to the insurance plan in the Carrier Allowed Amounts dropdown. This fee schedule is used to track out of network fees.
- Enter out of network / allowed amounts in the Procedure Code List, as you enter Insurance Claim Payments, or in the Claim Procedures (claimprocs). Once entered, allowed/out of network fees are used for all estimates instead of the regular fee.
Note: Be careful when entering out of network fees. Make sure you enter the true allowed amount, not a fee reduced by deductible, etc.
To turn automatic generation of fee schedules off, uncheck the Use Blue Book box. The out of network fees will continue to update automatically, but fee schedules will need to be managed manually.
To clean up unused out of network fee schedules, see Fee Schedules.
Use the Blue Book feature sparingly until we can make improvements. Some of the problems identified are:
- It can make fee schedules hard to manage, especially if you have lots of plans that are automatically duplicated. Your fee schedule list can become very cluttered.
- Since the names are by carrier, we have had complaints that this is not fine-grained enough. Users would rather organize the allowed/out of network fee schedules at the plan level.
Our plan is to no longer show Blue Book fee schedules in the Fee Schedules window. We will instead build a new interface, accessible directly from the Edit Insurance Plan window. The tool should let users see historical trends for each code and fine-tune what the future estimates should be for each code. This is feature request #2099.