Is "Carrier allowed amounts" only for use w/out-of-network?

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gillamrobert
Posts: 10
Joined: Wed Jul 18, 2012 5:43 am

Is "Carrier allowed amounts" only for use w/out-of-network?

Post by gillamrobert » Fri Feb 27, 2015 12:35 pm

I have been playing around w/allowed fee schedules but can only get it to work if I select plan type as Category percentage (which is a problem b/c the tx plan will not show the PPO discount). Is this the way it is supposed to work? In other words, for a PPO plan type the carrier allowed amounts will not apply to the estimates?

spsheffield
Posts: 19
Joined: Sat Feb 11, 2012 6:30 pm

Re: Is "Carrier allowed amounts" only for use w/out-of-netwo

Post by spsheffield » Fri Feb 27, 2015 1:13 pm

As far as I know, you would only want to use an allowed fee schedule of you are out of network but somehow still have access to the allowed fee schedule for that insurance company. For a PPO, you would enter the contracted fee schedule as a normal fee schedule, then under the insurance plan edit window select the plan type as PPO and then select the PPO fee schedule from the drop down list. This will give you accurate estimates because it will equate write offs based on the PPO's fee schedule you entered.

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