Checking Insurance Information

---

Description

This quick guide demonstrates what to check and update with insurance plans after conversion.

Contents

The following topics are covered in this quick guide:

• Section 1 - Understanding the Policy Information
• Section 2 - Understanding the Plan Information
• Section 3 - Understanding the Carrier Information

---

Steps

Section 1 - Understanding the Policy Information

1. The patient's Policy Information can be accessed from the Sidekick. With the correct patient at the top of the Sidekick, click the Insurance drop-down arrow to expand the insurance summary.

   

2. If the patient has insurance, the insurance plan will display. Click the Insurance Plan.

   

3. On the Policy Information page, each of the fields can be edited by clicking the blue text or blank line.

   

4. The insurance plan is already set, so leave this field as it is.

   

5. The Subscriber field indicates who the subscriber on the insurance policy is. A patient or non-patient contact can be a subscriber on a policy. This field is required for an electronic claim to be sent.

   

6. The Subscriber ID field is where the subscriber or member identification number is entered. This is also a required field for an electronic claim to be sent.

   

7. The Renewal Date for Policy field indicates the month the dental benefits of this policy start over. Most plans are on a calendar year, so this will be set to January by default.

   

8. To change the renewal date, click this field and select a new month from the drop down list.

   

9. The next field indicates what the policy start date is. No claims can be sent for the patient prior to this date. This field defaults to the current date.

   

10. Click this field and select the effective date for the policy from the calendar.

    

11. The next field indicates the date the policy ends. This field is typically left blank, unless it is helpful to set a termination date for the patient's coverage.

    

12. The next few fields are the card sequence (1), dependent code (2), and member identifier (3). If any of these fields apply to the patient's policy, edit the information for the respective field.

    

13. The next field indicates whether the insurance is Assignment or Non-Assignment and determines whether or not the information required to submit a claim on behalf of the patient in included when a claim is sent. Leave this as Assignment unless the intent is to print off a manual claim to give to the patient for them to mail in themselves.

    

14. Next is the field to indicate the patient's Relationship to Subscriber. Click this field and make sure the correct option is selected.

    

15. If this is an existing policy, the fields to indicate Activity Outside of Curve Hero may need to be edited. Click Edit Outside Maximums Used to enter any benefits the patient has used at another office or prior to conversion to Curve. Click OK to save the entered information and close the window,

    

    

16. Click Edit Outside Deductibles Used to enter any deductibles that have been met at another office or prior to conversion to Curve. Click OK to save the entered information and close the window,

    

    

17. Click Edit Frequency History to enter any frequency activity that has occurred at another office or prior to conversion to Curve. Click the checkmark to save the information, the click Close to close the window,

    

    

    

    

18. To access the Plan Information, click Edit Plan.

    

---

Section 2 - Understanding the Plan Information

1. The Plan Information page is separated into two sections. The top is the Plan Information section (1), and the bottom is the Coverage details section (2).

   

2. It is important to understand that the information on this page might be linked to other patients that have this same insurance plan, so do not change the Plan Name field.

   

3. The next field is the Carrier for Plan, this indicates the insurance company. Please refer to Section 3 to learn about verifying the carrier and carrier ID. Because this plan is likely linked to other patients, do not change the Carrier for Plan field.

   

4. The Plan Group Number field should already have been matched. If it is not accurate, this plan is probably not the right plan for this patient. Choose a different plan or add a new plan rather than change the Plan Group Number field.

   

5. The Division field is only filled in when it is applicable to the plan, and is often left blank.

   

6. The next field is for the Fee Guide. When this field is clicked, it will display all the available fee guides in the database allowing for the selection of the correct one. This fee guide determines what fees will be used for the insurance estimates on appointments, treatment plans, and invoices.

   

   

7. The next field is Fee Guide to Send on Claims. When this field is clicked, it will display all the available fee guides in the database allowing for the selection of the correct one. This is typically set to the regular office fee guide, which most offices prefer to go out on their claims.

   

   

8. The field for Claim Filing Type will determine if the insurance is in network or out of network, and determines if the PPO Write-Off will be estimated. Make sure this field is set to Preferred Provider Organization (PPO) if the plan is in network. If the plan is out of network, select Commercial Insurance Co. from the list. When Commercial Insurance Co. is selected, Curve will not provide PPO Write-Off estimates for the plan.

   

   

9. If the Claim Filing Type is set to Preferred Provider Organization (PPO), a box will display beneath the field. If this box is checked, the patient estimates will display the insurance allowed rate for any procedures that are not covered under the plan. If this box is not checked, the full office fee will display for any procedures that are not covered under this plan.

   

10. The next field is Plan Note. Click this field to enter any additional notes specific to this plan.

    

11. Any notes that are entered in this field are viewable in the Sidekick by clicking the Insurance drop-down arrow, then opening the Plan Details.

    

12. The bottom portion of the Plan Information page is the Coverage section. The details entered in this section will determine how the insurance and patient portions are estimated.

    

13. The section for Maximums is where the Individual and Family maximums are entered.

    

14. The section for Deductibles is where the deductible values are entered.

    

15. The Coverage Table Summary is where the percentages of coverage are entered by category, subcategory, and procedure code. Click Edit Coverage Table to edit the percentages.

    

    

16. If a specific procedure is covered at a specific amount rather than a percentage, that amount can be recorded in the Payment Table. Click Edit Payment Table to add these amounts.

    

    

17. If there are any special plan details such as Age Limits, Downgrades, Frequencies, Waiting Periods, or Deductible Exemptions, they can be added in the Plan Details. Click Edit Plan Details to add these specifics.

    

    

18. To access the Carrier Information, click Edit Carrier.

    

---

Section 3 - Understanding the Carrier Information

1. The Carrier Information page contains all the details associated with the insurance carrier. Anything that is edited on this page affects all the plans that are attached to the carrier.

   

2. Most of the information on this page should not be changed. It is, however, very important to make sure the Carrier ID fields are correct. These are the electronic addresses for the carrier, and determine where all the claims to this carrier will go.

   

3. To verify the carrier ID with DentalXChange, the clearing house that sends electronic claims for Curve, click Check Carrier.

   

4. This link opens the DentalXChange Payer List. Use the Search function to find or verify a carrier ID.

   

5. The carrier Address is also required for electronic claims to go through.

   

6. The other contact information is not required to send claims, but may be useful as a reference.

   

7. The remaining fields are situational. Only edit them if the need arises.