Insurance Allowed amount Entered from EOB

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SriramChellappan
Posts: 42
Joined: Thu Mar 11, 2021 2:45 pm

Insurance Allowed amount Entered from EOB

Post by SriramChellappan » Wed Apr 21, 2021 9:28 am

I believe this was added in the recent release. When entering EOB we are able to enter the Allowed amount specified in the EOB. Wondering which table and column this data is stored.

I would like to run a query that shows the fee schedule in the database and the allowed amount from the EOB. this will help us keep the fee schedule as accurate as possible.

joes
Posts: 239
Joined: Tue Aug 13, 2019 12:41 pm

Re: Insurance Allowed amount Entered from EOB

Post by joes » Wed Apr 21, 2021 2:59 pm

Allowed amounts entered while entering an EOB are stored in the AllowedOverride column of the claimproc table. I should also mention that we have a Blue Book feature for tracking allowed amounts that you can read more about here: https://www.opendental.com/manual/bluebook.html.
Joe Sullivan
Open Dental Software
http://www.opendental.com

SriramChellappan
Posts: 42
Joined: Thu Mar 11, 2021 2:45 pm

Re: Insurance Allowed amount Entered from EOB

Post by SriramChellappan » Thu Apr 22, 2021 6:56 am

The allowedOverRide in ClaimProc has the following def

The allowed fee (not the override) is a complex calculation which is performed on the fly in Procedure.ComputeEstimates/ClaimProc.ComputeBaseEst. It is the amount that the percentage is based on. If this carrier has a lower UCR than the office, then the allowed fee is where that is handled. It can be pulled from an allowed fee schedule. It is also where substitutions for posterior composites are handled. The AllowedOverride allows the user to override the calculation. -1 indicates blank. A new use of this field is for when entering insurance payments. On the eob, it will tell you what the allowed/UCR fee is. The user will now be able to enter this information into the AllowedOverride field. They will simultaneously pass the info to the allowed fee schedule. AllowedOverride is never changed automatically by the program except to sometimes set it to -1 if NoBillIns.

Joes are you referring to this column in ClaimProc table?

joes
Posts: 239
Joined: Tue Aug 13, 2019 12:41 pm

Re: Insurance Allowed amount Entered from EOB

Post by joes » Thu Apr 22, 2021 8:41 am

Yes, that is the table and column that I was referring to. When a value is entered in the Allowed column of the Enter Payment window while receiving a claim, the value is saved as the AllowedOverride for the given ClaimProc. The window I am referring to can be seen in our manual, here: https://www.opendental.com/manual211/claimreceive.html. For Category Percentage plans, this data is also saved to the AllowedOverride column of the insbluebook table for use by the Blue Book feature that I mentioned.
Joe Sullivan
Open Dental Software
http://www.opendental.com

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