As it becomes more common to be an out-of-network provider, it becomes even more important to track insurance fees to give your patients the most accurate estimates you can. In this post, we will be highlighting the Blue Book feature that allows you to record insurance-allowed fees for out-of-network plans as you receive claims.
Setting it Up
First, enable the feature in Setup, Family/Insurance, Blue Book. We’ll be discussing the “Blue Book” option, rather than “Legacy Blue Book” which this feature replaced. If your office used the feature in older versions of Open Dental, you may have the legacy feature enabled.
From here, you can decide how you want the allowed fees to be determined. There is a default Insurance Blue Book Rules Hierarchy that should work for most practices, but rules can be moved Up or Down in the hierarchy if needed. We recommend always leaving “UCR fee” at the bottom, as this should be used only in the absence of other fees.
For the “Allowed fees” rules, you can determine which fee will be used, Most Recent, Average, or Median. Most Recent is the default. Lastly, you’ll want to set the “UCR Fee Percent”. This determines what percentage of the UCR fee is used when that rule is utilized. So, rather than estimating insurance coverage using the full UCR fee, it is based on a lower percentage (e.g., UCR Fee Percentage = 80, and UCR Fee = $100, the insurance allowed fee is calculated at $80).
Setting up Manual Blue Book Fee Schedules
If you happen to have a copy of the insurance fees, you can enter these fees into a Manual Blue Book fee schedule that can override the fees entered into claims. Additionally, if your office was previously using the legacy feature, you can copy the fees from the old out-of-network fee schedule into a new Manual Blue Book fee schedule for use with the newer feature.
Setting up Insurance Plans
To properly utilize this feature, you’ll need to make sure that out-of-network plans are set up correctly. Set the insurance “Plan Type” to Category Percentage and, if you have one, attach the Manual Blue Book fee schedule in the Carrier Allowed Amounts area. The Fee Schedule row should be set to None and the “Use Blue Book” box should be checked.
Start Tracking Allowed Amounts
Now that you’ve enabled and set up the feature, start entering the Allowed amount from your EOBs when receiving claims.
These fees will be used to determine the allowed amount when treatment planning procedures. You can see the history of the calculated allowed amount from the Claim Procedure.
If you need help setting up this feature or just have questions, reach out to our friendly and helpful support staff.
Information in this post reflects features available in Open Dental Version 24.1. For the most up-to-date information, please visit our manual.