Insurance Categories

In the Main Menu, click Setup, Family/Insurance, Insurance Categories.

Insurance categories allow automatic calculations of insurance coverage based on the procedure code.

Note: Do not alter insurance categories unless you understand what you are doing. Insurance Categories are global. Changes may affect all plans.

Coverage 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. The categories that exist affect the categories available when creating an insurance benefit. Coverage categories are completely unrelated to procedure code categories.

Description: The category name.

Default Percent: The category's default percentage when creating a new insurance plan (Insurance Plan). Changing this number only changes the default value for future insurance plans and does not affect existing patient plans. If the percent is left blank, this category will not show as a default benefit in new insurance plans.

Is Hidden: Remove this category as a selection option on the Edit Benefit Window (Edit Benefits - Row View).

Electronic Benefit Category: One of each E-benefit category must be assigned to a corresponding category. There can be no duplicates and no missing categories. Electronic Benefit Categories are used during the Electronic Eligibility and Benefits process.

Coverage Spans

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 you to put whatever procedures you want 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.

To add a coverage span, click Add Span, or double-click a coverage span row to edit.

Open Dental warns you if the code is not in the correct ADA format (at least the first 5 digits), but you can still use such codes if you wish.

If you have a category that is a subset of another span, then that category should be lower in the list.