Checking Frequencies or Issues Before Financial Arrangement

[ryansmithdds]

I was wondering if anyone has any options or work arounds to help us with this.

No matter how much I train staff etc to catch potential insurance issues before we do the work, it seems that things are always slipping through the cracks. One example is doing a crown but it has only been 6 years and insurance has 7 year frequency, or things like crown lengthening is not covered when done with any other procedure etc.

Is there a way when creating a tx plan or at any step that some automation could be applied to have a warning or pop up reminder to verify the frequency on something or just a way to help catch these ridiculous issues that keep recurring?

thanks!

[dgraffeo]

We're actually currently working on a feature to help alleviate that issue. If a procedure is attached to an appointment and scheduled, it will check frequency information for the procedures and display warnings if there are conflicts.

[ryansmithdds]

That would be awesome! and it would really help us!

Being that you are working on it maybe if anyone out there could help brainstorm to offer any tips on best way to make it work. When attached to an appointment would work or even when attached to a tx plan to be created would be nice since when tx plans are created is the time when the financial arrangements are probably occurring. Also if there was a way to customize it so other things could be done besides frequency checking, like if a sedation procedure is attached it could remind them to give pre op instructions......
or if a surgical procedure is done, it could remind them to verify no medical complications etc.....
or another thing could be popups or reminders if a procedure code is attached to a patient and the doctor or appt time is less that what is set, it could remind us....

Not sure what level of flexibility could be employed with the idea but there are a ton of things that this could be used for to help give staff a safety net to not mess up so much

I will look at the future version updates for this!
Thanks!

[dgraffeo]

As far as treatment plans are concerned, in the most recent versions of Open Dental (16.3) there is a date picker at the top if the "Enable Insurance Frequency Checking in Treatment Plans" preference is set to true. You can select a date with that and press the "Refresh" button and it will update the treatment planned procedure amounts to act as if they were treatment planned for the date selected. For instance, if you want to see what things would cost on the first of next month, you would set the date picker to Nov 1st, hit Refresh, and it will calculate the amounts as if it were Nov 1st. 16.3 is the beta though, so update to it at your own risk. None of the changes to the procedure amounts are saved to the database, so you aren't changing any date, it's just displaying them for you.

[boboffice]

I'd like the treatment plan to respect the frequency limitations. For example, if a patient needs 4 cleanings this year and the frequency limitation is two, I'd like to enter all four into the treatment plan and the third and fourth to show the write-off but not any insurance payment. Can this be done?

[allends]

Here is a link to our manual describing how to setup and use the frequency limitation system.
https://www.opendental.com/manual203/in ... tions.html

[rinse-dental]

@adearmondsattler -- I know this is an old thread but relevant to our situation. Is there a way to consider Existing Other procedures in the patient's chart? In our case, a Delta Dental patient has an existing crown that's 5 years old and the plan has a 7 year limitation. We've entered the EO crown with an initial completion date based on the history provided by Delta Dental but it appears to be ignored in the treatment plan estimate.

As far as we can tell, the only solution is to manually change the insurance estimate to 0.

[allends]

I believe this is what your are looking for.
https://www.opendental.com/manual/inshistory.html

[rinse-dental]

Okay. So, according to the manual, there is no way to consider a crown or filling limitation on a specific tooth for procedures performed outside our practice. It appears we’ll need to manually check and adjust the estimate.

Insurance History accounts for maximums, deductible, and the last date at the code level… it does not consider the tooth level. The exception is if we performed the procedure and marked it complete.

What’s odd is the ability to add the insurance limitation for crowns at 7 years (for example)… also, in the charted procedures, we can add an initial prosthetic date for a tooth, both on the EO procedure AND the TP procedure. Yet, the treatment plan estimate will not show the limitation in the estimate.

Just feels like I’m missing something