We recently had a reader ask us to address agreed fees in the ledger and UCR on insurance claims, and it reminded us of the importance of putting the Fee Schedule in the Ledger and the UCR on the insurance. Here are a few reasons and tips for doing so:
- For Treatment Planning, the team will not have to pull out the PPO fee schedule or use manual calculation every time you want to figure a patient’s estimated portion.
- When posting insurance Fee Schedules into Ledger, the office will have fewer adjustments on the ledgers. That means reducing billing errors, decreased Billing Statements being sent, more accurate estimated copays, and fewer adjustments. And that will give your office true daily production numbers.
- Using the DX2012F claim format will help ensure the insurance company sees your UCR (Office Fees) and pay their full allowable amount. This really helps if the insurance company updated fees and your office had not updated them into Dentrix yet.
- To make sure your office is always sending your UCR to the insurance company, set the DX2012F as the #1 Claim Format from Office Manager | Maintenance | Practice Setup | Definitions | Claim Format. If you see DX2012 and it does not have the “F” behind it, you will need to add the “F”. (If you cannot get the F to appear, try clicking Delete a few times at the end of DX2012.) Then select Change and, provided your office has left this claim format as the default, you can send your UCR to the insurance company.
- PPO negotiated fees are another reason to send your UCR fees to the insurance company. If you send your PPO negotiated fees and miss an update from the insurance company, you will never be paid for more than what you’re sending. You’ll also bring down the UCR fees for your entire zip code if you’re always sending the lower fee.
Our Dentrix Profitability Coaching Program does an Insurance and Collections topic that addresses this vital part of the practice. Check it out to learn more.