Description
This quick guide demonstrates how to add insurance plans details, including Age Limits, Frequencies, Deductible Exemptions, Downgrades, and Waiting Periods.
About
The insurance and patient estimates in Curve Hero are calculated from the details entered in the patient's Plan Information and Policy Information page. The more accurate the data is in these areas, the more accurate the patient's estimates will be.
Note
Many patients have the same plan, so once it is updated, the updates will be applicable to everyone else that has that same coverage.
Contents
Sections covered in this guide:
- Section 1 - Updating Benefits Used Outside of Curve Hero
- Section 2 - Updating Maximums
- Section 3 - Updating Deductibles
- Section 4 - Updating the Coverage Table
- Section 5 - Updating Plan Details
- Section 6 - Re-estimating Insurance
Steps
Section 1 - Updating Benefits Used Outside of Curve Hero
Any patients that have used any of their maximums and deductibles in the legacy software, will need to be have that updated in Curve Hero.
- Click the first insured patient's appointment on the schedule. This makes them the active patient.
2. Click the Insurance summary triangle in the Sidekick. If the patient has insurance coverage, the plan name and carrier name will display.
3. Click the plan name.
4. The Policy Information page displays. At the bottom are the three areas that can be updated to track any benefits the patient has used prior to going live in Curve Hero. These include Maximum activity outside of curve Hero, Deductible Activity outside of Curve Hero, and Frequency activity outside of Curve Hero.
Note: Any benefits that have been used by a new patient prior to coming to your clinic can be entered in this area. Likewise, benefits used at a specialist or other outside dental clinic can be entered here.
5. If any of the annual maximum has been used by the patient or covered family members, click Edit Outside Maximum Used.
6. The Maximums Used Outside of Curve Hero window opens. The Coverage section is separated into columns that represent different categories of coverage. These include Standard, Preventive, Basic, Major and Ortho.
7. If all the categories are included in a single annual maximum, click the 0.00 in the Standard column.
8. Type the amount that has been used of the active patient's annual maximum. Hit Enter on the keyboard.
9. If any of the other categories have a separate annual maximum, such as Ortho, and any of that amount has been used, click the 0.00 for that column, and enter the used amount.
10. In the Patient column, the patient's name displays in the first row. Beneath it any other family members on the same plan will display. If no other covered family members are in the clinic, the row will list Other. This is to add any used maximums for covered family members, which will apply to the plan family maximums. If applicable, click the 0.00 for the applicable category, and type the used amount.
11. Click OK.
12. If any deductible amount has been used, click Edit Outside Deductibles Used.
13. Add used (met) deductible amounts for the Patient and/or family (Other). Then click OK.
14. If there are any frequency activity that need to be recorded, click Edit Frequency History.
15. In the Frequencies outside Curve Hero window, click Add Activity.
16. Select the Patient applicable to the frequency.
17. Hit the Tab key on the keyboard twice, or click the Activity Date field. Click the calendar icon.
18. Using the back and forward arrows, or the Month/Year dropdown, select the month, then the date of the previous date of the applicable procedure.
19. If the procedure is specific by site, click the Per Tooth? box.
20. Click the Codes field. Type the applicable procedure code, then click to select it. Add all the procedure codes that are grouped with this procedure for this frequency.
21. If the Per Tooth? box is checked, click the Tooth field. Type the site, or scroll and select it.
22. Click the checkmark to save the frequency information.
23. Add additional activity as needed. Click Close when finished.
- On the Policy Information page, click Edit Plan.
2. Verify all the Plan Information, and make any edits as needed.
Important note: Any edits that are made on the Plan Information page affect all the patients that have coverage under this plan.
3. If the maximums need to be edited, in the Maximums section, click Edit.
4. Each of the rows in the Maximums window represent a category. Each has an Individual Amount and a Family Amount field, as well as a Frequency. Click the Individual Amount field, and type the amount.
5. To update the family maximum, click the Family Amount field, and type the amount.
6. The Frequency is set to Annual by default. If needed, click the Frequency field, and select Lifetime.
7. Each of the other categories can be unchecked if they are not included in the standard maximum. If applicable, fill out the remaining fields in the category row.
8. Click Save.
Section 3 - Updating Deductibles
- If the deductibles need to be edited, click Edit.
2. Most insurance have all or most of the categories fall under the standard deductible. If any of the other categories do not, click the box beside them to remove them from it.
3. Click the Individual Amount field, and type the amount.
4. If there is a Family Deductible, click that field, and type the amount.
Important note: If the plan does not have a family deductible, do not enter $0.00 in the Family Amount field. This amount overrides the individual deductible amount, so if the family deductible is set to $0.00, no estimate will include a deductible.
5. If needed, tab or click the Frequency field. The default is set to Annual, so if the Standard deductible needs to be changed, click Lifetime.
6. If any of the other categories are not included in the Standard deductible, set the Individual Amount, the Family Amount, and the Frequency. Click Save.
Section 4 - Updating the Coverage Table
- The next thing that may need to be updated is the percentages in the Coverage Table. If any of these needs to be edited, click Edit Coverage Table.
2. Click any of the numbers to the right of the category, and type the correct value for the percentage. This will apply to all the procedures within that category.
3. Any of the categories can be expanded to subcategories, and any subcategory can be expanded to display the procedures. Click the dropdown arrow to change the percentage for these.
Note: If a percentage is added in the subcategory line, it will apply to all the procedures in that subcategory. This amount will override any amount in the category field. If a percentage is entered for a specific procedure, it will override any amount that may be entered in the category or subcategory line.
4. When finished, click OK.
Section 5 - Updating Plan Details
- Lastly, the Plan Details can be edited or added. This includes age limits, downgrades, frequencies, waiting periods and deductible exemptions. Click Edit Plan Details.
2. The Plan Details window opens to the Age Limits page. Fluoride and Sealant groups are already added, but no age limit is set. To set an age limit for Fluoride, hover over it and click the edit icon.
3.The group Name is required. It can be left as it is, or type a preferred name.
4. Use the Tab key on the keyboard, or click the first No Limit field in the Age Limits column. This field is for the minimum age limit. If there is no minimum age limit, click to the next field. This is where the maximum age limit can be entered.
5. The fluoride codes are already added. Click the X to remove one, or click the Codes box to add additional codes. Scroll the dropdown code list, and click the desired code to add it to the age limit group.
6. When all the intended procedure codes are included, click the checkmark to save the group.
7. Additional groups can be added as needed. To do so, click Add Group.
8. If the plan has Downgrades, click that tab.
9. Click Add Downgrade.
10. Downgrades are entered by code. In the Code field, type the procedure code. Select it in the dropdown list.
11. Click or tab to the Downgrade Code search field. Type the procedure code to which the first code is downgraded.
12. Click the Site field. If the downgrade code is not applicable to any site, leave this at None. If it is Per Tooth, Per Quad, or Per Arch, click the applicable option.
13. Click Site Inclusions. This can be left at All, or click the applicable option.
14. Click the checkmark to save the downgrade.
15. To update Frequencies, click that tab.
16. There are many groups already added. Each of these includes the procedure codes that are associated with that group. To set the frequency for a group, hover over the group, and click the Edit icon.
17. The group can be renamed as desired.
18. Click None in the Frequency column. Select the option that fits this group of procedure codes.
19. In the next field, type the Amount that fits the variable X in the previous field.
20. In the next field, select the designation for the group of codes.
21. The next field is for site inclusion. Select the applicable option(s). Leave this field set to All if none of these applies.
22. In the Codes box, add or remove the applicable procedure codes.
23. Click the checkmark to save the frequency group.
24. If there are Waiting Periods to be updated, click that tab.
15. These can be set by category if all the procedures in the category are included in the waiting period. Click the category dropdown arrow to access subcategories.
16. If all the procedure codes within a subcategory fall under the same waiting period, hover over it, and click the Edit icon.
17. The default waiting period is set to Months. If the category/subcategory/procedure is counted in other increments, click this field.
18. Select the waiting period interval that best fits this instance.
19. Click the X, and type the amount for the interval.
20. Click the checkmark to save this waiting period.
21. To update Deductible Exemptions, click that tab.
22. Each of the categories displays. If the entire category should be removed from the deductible, hover over it, and click the Edit icon. Or click the Category to expand it.
23. If editing a category, click the box beside the procedure code(s) to include it in the exemption.
23. When all the desired codes are included in the exemption, click the checkmark to save it.
24. When all the plan details are entered, click Close.
25. Click Save Plan.
26. Verify everything is correct on the Policy Information page, and make any additional updates as needed. Click Save Policy.
Section 6 - Re-Estimating Insurance
- Once the insurance information has been updated, the treatment plans, appointments and/or invoices can be updated for the patient. To update today's appointment, click Today in the mini calendar.
2. Locate the appointment on the schedule, and double click it to open it.
3. To update the estimates, click Recalculate Costs.
4. A pop-up message describes what this action does. Click Yes.
5. The appointment estimates are recalculated according to the updated plan information. Click Update appointment.
6. When the costs are updated in an appointment, the visit on the treatment plan card in Charting is also updated. Visits can be updated in Charting as well. To do this, click Charting.
7. In the Charting module, locate the treatment plan card.
8. Right click the treatment card, and click Re-estimate Insurance.
9. The estimates are updated to reflect the new coverage details.
10. If the estimates did not get updated in the appointment or the treatment plan, they can be updated from the invoice. Click Billing.
11. Right click the invoice, and click Re-estimate Insurance.
12. A message pops up to explain the function. Click Yes.
13. The insurance and patient estimates recalculate to reflect the updated coverage details
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