One insurance plan with different fees

[cizcoa]

In OD is possible to put on the patient's insurance plan different fees depending on the provider? In our office we have different specialties providers that treat the same patient and we have an insurance plan that has different fees, depending on the specialty.

[Hersheydmd]

You can definitely set up separate fee schedules for each provider. You would set the Fee Schedule you want used for each provider in the Edit Provider window.
I also think that if you set the insurance plan up as a "Category Percentage" and choose "none" for Fee Schedule, then whatever fee schedule is being used for the procedure (based on the provider) will also be used for the insurance claim. Haven't tested it, but it makes sense.

[Arna]

Dr Hershey is right, you can set up different fee schedules for your different providers. You can assign fees in Lists>Providers. This will be the fee schedule that each provider bills.

If the insurance plan in question pays differently based on the provider who completed the work, that requires a little more information. There are a lot of variables that come in to play when looking at a scenario like this.
1.Are both your generalists and specialists in network(PPO)/out of network or a combination thereof?
2.Do your specialists and generalists EVER perform the same procedure? (Eg. If you had an endodontist on site, would general dental do root canals ever?)
3.What are you hoping to achieve with this setup? Accurate Tx Plans estimates?

[Manny Ramirez]

Something that comes to mind is setting up a different database for each provider, each database can have a different set of fee schedules.

[Hersheydmd]

Something that comes to mind is setting up a different database for each provider, each database can have a different set of fee schedules.

That isn't necessary when you can set up different fee schedules for each provider in the office. Why would you want to juggle several databases at the same time? How would you handle different providers seeing the same patient at different times? You would have to enter all you patients in each providers database. It would be a nightmare to keep track of their accounts and insurance. Not a good idea.

[Manny Ramirez]

Yes indeed, haven't thought of that. But I think the initial post is in regards to different providers getting paid the specialist PPO. I guess that defining the insurance as PPO percentage will do the trick. When sending the claim one have to make sure that you send the correct billing and treating provider in the claim.