Learn how to create insurance plans and attach them to patients by viewing an interactive guide or step-by-step instructions.

How to add an in-network in insurance plan

Choose an option to jump to the applicable setup steps:

• How to set up if you want to track write-offs (recommended)
• How to set up if you don't want to track write-offs (not recommended)

How to set up an in-network plan if you want to track write-offs (recommended)

1. Select the patient and go to the Family Module.
2. In the top toolbar, click Add Insurance.
3. Answer the prompt Is the patient the subscriber?
• If No, select the subscriber on the next window.
4. If there are existing or previous insurance plans connected to the subscriber, you will be prompted to select one.
• If the plan you want to add is on the list, select it and click OK. Skip to Step 9.
• If the plan you want to add is not on the list, click Add New.
5. In the Edit Insurance Plan window, click Pick from List.
   • If the plan is on the list, double-click it and skip to Step 9.
   • If the plan is not on the list, proceed to the next step.
6. Enter plan details (e.g., employer, carrier, group number, etc.)
   • If an existing carrier is not selected, a new carrier will be created. When typing in the Carrier text box, existing matching carriers are displayed. Click an existing carrier to use it and automatically fill out additional carrier information. Alternatively, click the [...] button to open the Carriers List to find an existing carrier.
7. Choose the Plan Type:
   • If insurance pays based on a percentage of the allowed/contracted fee for a procedure, choose PPO Percentage.
   • If insurance pays a fixed amount per procedure, choose PPO Fixed Benefit.
8. Assign fee schedules to the plan:
   • For both plan types, select the allowed/contracted fee schedule in the Fee Schedule dropdown.
   • For PPO Fixed Benefit plans, select the insurance coverage amounts from the Fixed Benefit Amounts dropdown
9. Enter the Relationship to Subscriber and Subscriber ID.
10. Click Save.

Once the plan is created, you can set up the insurance benefits. See Benefits for more information.

How to set up an in-network plan if you do not want to track write-offs (not recommended)

1. Select the patient and go to the Family Module.
2. In the top toolbar, click Add Insurance.
3. Answer the prompt Is the patient the subscriber?
• If No, select the subscriber on the next window.
4. If there are existing or previous insurance plans connected to the subscriber, you will be prompted to select one.
• If the plan you want to add is on the list, select it and click OK. Skip to Step 9.
• If the plan you want to add is not on the list, click Add New.
5. In the Edit Insurance Plan window, click Pick from List.
   • If the plan is on the list, double-click it and skip to Step 9.
   • If the plan is not on the list, proceed to the next step.
6. Enter plan details (e.g., employer, carrier, group number, etc.)
   • If an existing carrier is not selected, a new carrier will be created. When typing in the Carrier text box, existing matching carriers are displayed. Click an existing carrier to use it and automatically fill out additional carrier information. Alternatively, click the [...] button to open the Carriers List to find an existing carrier.
7. Choose Category Percentage from the Plan Type dropdown.
8. Choose the allowed/contracted fee schedule from the Fee Schedule dropdown.
9. Enter the Relationship to Subscriber and Subscriber ID.
10. Click Save.

Once the plan is created, you can set up the insurance benefits. See Benefits for more information.

How to add an out-of-network insurance plan

Use this setup when you are not contracted with an insurance carrier.

1. Select the patient and go to the Family Module.
2. In the top toolbar, click Add Insurance.
3. Answer the prompt Is the patient the subscriber?
• If No, select the subscriber on the next window.
4. If there are existing or previous insurance plans connected to the subscriber, you will be prompted to select one.
• If the plan you want to add is on the list, select it and click OK. Skip to Step 9.
• If the plan you want to add is not on the list, click Add New.
5. In the Edit Insurance Plan window, click Pick from List.
   • If the plan is on the list, double-click it and skip to Step 9.
   • If the plan is not on the list, proceed to the next step.
6. Enter plan details (e.g., employer, carrier, group number, etc.)
   • If an existing carrier is not selected, a new carrier will be created. When typing in the Carrier text box, existing matching carriers are displayed. Click an existing carrier to use it and automatically fill out additional carrier information. Alternatively, click the [...] button to open the Carriers List to find an existing carrier.
7. Choose Category Percentage from the Plan Type dropdown.
8. Optional: Check Use Blue Book to track insurance fees when receiving claims. This can help calculate more accurate insurance estimates.
   • If you have a fee schedule for the plan, select it from the Manual Blue Book dropdown.
9. Enter the Relationship to Subscriber and Subscriber ID.
10. Click Save.

Once the plan is created, you can set up the insurance benefits. See Benefits for more information.

How to add a Medicaid insurance plan

These steps can also be used to set up other insurance plans where patients pay a flat copay for procedures and insurance covers any remaining balance.

1. Select the patient and go to the Family Module.
2. In the top toolbar, click Add Insurance.
3. Answer the prompt Is the patient the subscriber?
• If No, select the subscriber on the next window.
4. If there are existing or previous insurance plans connected to the subscriber, you will be prompted to select one.
• If the plan you want to add is on the list, select it and click OK. Skip to Step 9.
• If the plan you want to add is not on the list, click Add New.
5. In the Edit Insurance Plan window, click Pick from List.
   • If the plan is on the list, double-click it and skip to Step 9.
   • If the plan is not on the list, proceed to the next step.
6. Enter plan details (e.g., employer, carrier, group number, etc.)
   • If an existing carrier is not selected, a new carrier will be created. When typing in the Carrier text box, existing matching carriers are displayed. Click an existing carrier to use it and automatically fill out additional carrier information. Alternatively, click the [...] button to open the Carriers List to find an existing carrier.
7. Choose Medicaid or Flat Co-Pay from the Plan Type dropdown.
8. If the patient pays a copay for procedures, choose the fee schedule from the Patient Co-pay Amountsdropdown.
9. Enter the Relationship to Subscriber and Subscriber ID.
10. Click Save.

Once the plan is created, you can set up the insurance benefits. See Benefits for more information.

How to add an HMO/DMO plan with no co-pays

These types of plans are also sometimes referred to as Capitation plans.

1. Select the patient and go to the Family Module.
2. In the top toolbar, click Add Insurance.
3. Answer the prompt Is the patient the subscriber?
• If No, select the subscriber on the next window.
4. If there are existing or previous insurance plans connected to the subscriber, you will be prompted to select one.
• If the plan you want to add is on the list, select it and click OK. Skip to Step 9.
• If the plan you want to add is not on the list, click Add New.
5. In the Edit Insurance Plan window, click Pick from List.
   • If the plan is on the list, double-click it and skip to Step 9.
   • If the plan is not on the list, proceed to the next step.
6. Enter plan details (e.g., employer, carrier, group number, etc.)
   • If an existing carrier is not selected, a new carrier will be created. When typing in the Carrier text box, existing matching carriers are displayed. Click an existing carrier to use it and automatically fill out additional carrier information. Alternatively, click the [...] button to open the Carriers List to find an existing carrier.
7. Choose Capitation from the Plan Type dropdown.
8. If the patient pays a copay for procedures, choose the fee schedule from the Patient Co-pay Amountsdropdown.
9. Enter the Relationship to Subscriber and Subscriber ID.
10. Click Save.

Once the plan is created, you can set up the insurance benefits. See Benefits for more information.

How to add an HMO/DMO plan with copays and supplemental payments

These types of plans are also sometimes referred to as Mixed Capitation plans. This insurance plan setup tracks write-offs and is common in Texas (e.g., CHIP, MCNA, DentaQuest, Medicaid) These types of plans are also sometimes referred to as Capitation plans.

1. Select the patient and go to the Family Module.
2. In the top toolbar, click Add Insurance.
3. Answer the prompt Is the patient the subscriber?
• If No, select the subscriber on the next window.
4. If there are existing or previous insurance plans connected to the subscriber, you will be prompted to select one.
• If the plan you want to add is on the list, select it and click OK. Skip to Step 10.
• If the plan you want to add is not on the list, click Add New.
5. In the Edit Insurance Plan window, click Pick from List.
   • If the plan is on the list, double-click it and skip to Step 10.
   • If the plan is not on the list, proceed to the next step.
6. Enter plan details (e.g., employer, carrier, group number, etc.)
   • If an existing carrier is not selected, a new carrier will be created. When typing in the Carrier text box, existing matching carriers are displayed. Click an existing carrier to use it and automatically fill out additional carrier information. Alternatively, click the [...] button to open the Carriers List to find an existing carrier.
7. Choose PPO Percentage from the Plan Type dropdown.
8. In the Fee Schedule dropdown, choose the fee schedule with the insurance procedure fees (Supplemental Amounts + Patient Copay).
9. If the patient pays a copay for procedures, choose the fee schedule from the Patient Co-pay Amountsdropdown.
10. Enter the Relationship to Subscriber and Subscriber ID.
11. Click Save.

Once the plan is created, you can set up the insurance benefits. See Benefits for more information.

Additional Resources

• Insurance Plan
• Insurance Benefits
• Fee Schedules
• Insurance Plan Types
  • PPO Insurance Plan
  • PPO Fixed Benefit Insurance Plan
  • Category Percentage Insurance Plan
  • Capitation ( HMO / DMO ) Insurance Plan
  • HMO / DMO Insurance Plan with Co-pays
  • Medicaid or Flat Co-Pay Insurance Plan
• Medical Insurance