Frequency Limitations

Insurance frequency limitations may or may not affect estimates of treatment planned procedures, depending on preferences.

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

When insurance frequency checking is enabled:

Set up and Enable Frequency Checking

Frequency checking is enabled by default. If it needs to be re-enabled, in Treatment Plan Module Preferences, check Enable Insurance Frequency Checking and select the codes affected by each limitation. Default codes are already included, but can be changed as needed.

Benefit Frequencies

Enter the plan's frequency limitations in the Edit Benefits window. Click More to add additional frequency limitations.

To enter a benefit frequency, choose the frequency type from the drop down and enter the corresponding number in the # box.

For each frequency limitation type added, a row will show in the Family module, Insurance Plan area.

For additional options for frequency limitations (e.g., override frequency for a specific patient), see Other Benefits.

View Estimates for Treatment Planned Procedures

In the Treatment Plan module, click the Estimates as of dropdown and select the date. Once a date is selected, treatment plan estimates will be updated to reflect the chosen date.

When a procedure is not covered due to a frequency limitation, the procedure's description will indicate this.

Note: For completed procedures to affect frequency limitations in the treatment plan, the completed procedure must be attached to an insurance claim for the same insurance plan. Procedures will affect frequency once attached to a claim, even if the claim is denied or insurance pays $0. Dates entered into Insurance History will also be considered.

Example

Frequency limitation for BWs is every 2 years. On 12/28/2019, patient had BWs taken and a claim was sent and received.

In the Edit Benefits window, enter the frequency limitation as shown below:

In the Treatment Plan Module:

When scheduling an appointment: