Insurance

FAQs Answered: Treatment Plan Module

treatment plan


Using the Treatment Plan module in Open Dental (Updated 12/16/19)

This post answers common questions on the Treatment Plan module in Open Dental.

Learn how to troubleshoot common issues with treatment plans, better organize and present treatment planned care to boost treatment plan acceptance, and manage preauthorizations.

Treatment Plan FAQs

I know that presenting essential care first boosts treatment plan acceptance. What’s the best way to do this in Open Dental?

Once you’ve charted the treatment, you can select and prioritize the procedures. Items with the same priority will group together, and be subtotaled. Color-code your priorities to identify them even more easily. Go to Setup, Definitions, Treat’ Plan Priorities to set colors.
TECH TIP: Prioritizing treatment makes creating planned appointments a breeze! Read more about using planned appointments here.

The patient accepted the treatment on a saved treatment plan. Can I schedule it now?

A saved treatment plan is like a snapshot in time, but the charted treatment should still be in the active treatment plan. Create the planned or scheduled appointment, and attach the treatment planned procedures. If the procedures were deleted after the treatment plan was saved, simply re-chart them (you can change the treatment planned date to reflect when they were originally charted/saved), then attach them to the appointment.

The insurance estimates don’t look right in the treatment plan, how can I troubleshoot this?

  1. Click “update fees” to update fees in the treatment plan you are seeing. This will pull in any fee schedule changes that have occurred since the item was treatment planned (both UCR and insurance fees). To update fees for all active treatment plans, run the Global Update Fees and Global Updates Writeoff Estimates tools – see more on our Update Fees manual page.
  2. Check to see if there is an “x” in the Sub column. If there is, insurance coverage is being downgraded (from composite to amalgam, for example). Open Dental is set to auto-downgrade codes unless the “Don’t Substitute Codes” option is checked in the patient’s insurance, Other Ins Info tab.
    In version 18.3 and greater, downgrades can be set by Insurance Plan. See more on that on our downgrades manual page.
    Pull up the Procedure codes list, and open up the procedure code. The Ins. Subst Code will show what code it is downgrading to. Check to make sure the office fee and insurance fee schedule fee is correct. If the insurance fee schedule doesn’t have a fee for the downgrade procedure, it will pull the UCR fee instead.
    TECH TIP: Write-offs are calculated using the UCR and Insurance fee schedule fees for the originally charted procedure code unless the PPO Substitution calculate write-offs box is unchecked. In this case, Open Dental adds the difference between the PPO amalgam fee and the UCR composite fee onto the patient’s portion.
  3. Check to make sure the attached insurance plan has the correct plan type. If the Fee in the treatment plan shows the insurance allowed amount, and no write-offs are showing, plan type is likely set to Category Percentage. If you are in-network and using an insurance fee schedule to calculate write-offs and insurance estimates, change the insurance plan type to PPO Percentage. Go back into the treatment plan – you should see the change reflected immediately.
  4. Check to make sure the insurance plan fee schedule has the most up-to-date fees. You can either:
    • Double-click to open the procedure (you can do this from the active treatment plan, then double-click to open the insurance estimate. The Insurance allowed amount will be displayed. If you know this is outdated, update the fee schedule OR
    • Go to Lists, Procedure Codes and pull up the insurance fee schedule, then check the allowed amount. Update the fee as needed.
      TECH TIP: To update active treatment planned fees for all patients, run the global update fees tool. If you just want to update the fees for this patient, go back into the patient’s treatment plan, and click the Update Fees button.
      TECH TIP: Don’t want the allowed column to show at all? Go to  Setup > Display Fields > Treatment Plan Module. Click on Allowed on the left, then use the blue arrow in the middle to move it to the right, under Available Fields.
      Treatment Plan
  5. Check to make sure your insurance category percentages and benefits are correct.
    TECH TIP: Insurance benefits are calculated after any deductible amounts have been applied. So on a procedure where the insurance covers 80% up to $200, if the patient has a $50 deductible remaining, they will take $200 – $50 = $150, then calculate the 80% on the $150, resulting in an insurance estimate of $120.

How can I customize how my treatment plan looks?

The treatment plan is a “sheet” that can be customized. For a how-to on this, you can:
treatment plan Watch the webinar, Sheets Customization.
Read more about Customizing Treatment Plans Using Sheets.

When I print my treatment plan, the tooth chart shows up as a black box – how do I fix this?

You’ll need to adjust your graphics settings.
Watch the webinar, Tooth Chart Graphics.
Read more about Graphic Settings.

If you want to remove the tooth chart from your treatment plan, follow the link above to edit the Treatment Plan Sheet.

 

Also In the Treatment Plan Module: Preauthorizations

How do I create a Preauthorization?

Get step-by-step instructions here on how to create and manage preauthorizations.

I received the preauthorization and entered the amounts but the insurance estimate in my treatment plan didn’t change – why is this happening?

When you receive the preauth, double-click to open the preauth, and be sure you’re clicking the “By Procedure” button, then enter the information you received from insurance. When entered this way, the estimates in the treatment plan will update to show the numbers you entered.

Where would I find preauthorizations not sent yet?

Any preauthorizations you’ve created but not sent can be seen both in the patient’s Treatment Plan Module and in the Manage Module – click the Send Claims button. Preauths will show 01/01/0001 as the date of service, and sort to the top under “Claims Waiting to Send.”

Is there a report that shows outstanding preauthorizations (preauthorizations I’ve sent but not received info back from insurance)?

Go to Reports, Standard, and in the Monthly section, open the Outstanding Insurance Claims report. Check the box at the top to “Include Preauths.” Click on the “Type” column to sort by that column – preauthorizations will show the word “Preauth” in this column. Adjust the Days Old (min) in the upper left as needed to see older or newer outstanding preauthorizations.

 

A penny for your thoughts...

This site uses Akismet to reduce spam. Learn how your comment data is processed.