Frequency Limitations

Insurance frequency limitations may or may not affect estimates of treatment planned procedures, depending on Preferences and Code Groups.

In the Edit Benefits window, at the left, is the Frequencies section.

When Enable Insurance Frequency Checking is checked in Preferences:

Set up and Enable Frequency Checking and Code Groups

Frequency checking is enabled by default by the Enable Insurance Frequency Checking preference.

The procedures affected by Frequency Limitations are determined by Code Groups. Default codes are already included, and new codes can be added as needed. It is not recommended to change or remove default codes as it can affect estimates or benefits.

Benefit Frequencies

Click More to open the Benefit Frequencies window and enter additional frequencies not displayed in the Edit Benefits window.

Code Group: Displays the Code Groups that have already been set up.

#: Click the column to type a value for the Frequency Limitation.

Frequency: Click to choose the frequency type from a dropdown.

Frequency Limitations in the Treatment Plan

In the Treatment Plan Module, click the Estimates as of dropdown and select a date (this defaults to the current date). Once a date is selected, treatment plan estimates are updated to reflect the chosen date. If a procedure is not covered due to a frequency limitation, as of the selected date, the procedure's description reflects this.

Double-click a procedure to view the Claim Procedures ( claimprocs ) with more insurance estimate details.

Completed procedures attached to a claim for the same insurance plan affect frequency limitation calculations. Dates entered into Insurance History are also considered. Once claims are received, denied procedures or procedures where insurance paid $0 are still counted toward the frequency.