Canada Insurance Categories
Canadian insurance categories allow automatic calculations of insurance coverage based on the procedure code.
Coverage Spans Grid: Displays the currently set categories and spans.
Categories: Coverage categories have specific procedure code spans attached according to typical insurance groupings. Categories are used to calculate the actual insurance coverage for specific procedures.
Add Span: Click to add a new coverage span. See Add Spans below.
Each coverage category can have unlimited spans of procedure codes attached. The default spans should work for most offices. Adding extra spans does not increase complexity for the staff. They will still only see the coverage categories set up. Spans simply allow whatever procedures are needed into each category. A span can be as short as a single code. Spans can be deleted although this will affect patient data if the span includes a patient's procedure (it does not corrupt the data). Changes to spans will affect the treatment plans of multiple patients.
Set to Defaults: Update existing spans in categories with an E-Benefit Categories assigned. The database must set to English (Canada). All E-Benefit Categories must be represented by an non-hidden Insurance Category in the list for the button to work.
Click Add, or double-click a category row to edit.
Click Add Span, or double-click a coverage span row to edit.
From Code / To Code: Enter the procedure codes for the span. Open Dental warns users if the code is not in the correct CDA format (at least the first 5 digits), but the codes can still be used if needed.
Older Open Dental installations may be using a Four-Part setup. Follow these instructions to convert to the recommended setup.
The resulting insurance category spans will look like this:
As new insurance plans are added, they will only use the new insurance categories. Part A and Part B categories will not be used.
Existing insurance plans will continue to use the old insurance categories and percentages unless the plans are manually edited. To do so, we recommend changing insurance plan Benefit Information via the Insurance Plans (Lists, Insurance Plans) so all subscribers are affected by the change.