If you treat a lot of out-of-network patients, Blue Book can help! This feature uses the allowed amounts entered on received claims to determine estimates for future procedures. This makes treatment plan estimates more accurate for your patients on out-of-network insurance plans. The video above runs through the process, but we’ll discuss them below as well.

Enable and set up Blue Book

To start using this feature, enable it in Setup > Family/Insurance > Insurance Blue Book.

Open Dental has a default hierarchy set up for how estimates will be calculated. We recommend you keep this hierarchy, however, if you would like to customize the hierarchy, you should know:

• You can determine the hierarchy order and the timeframe for each hierarchy.
• If you have in-network plans where write-offs are not tracked, you must keep Blue Book at the top of the hierarchy in order to continue utilizing the in-network fee schedules you’ve created.
• Your UCR fee schedule should always remain at the bottom of the list, as it will be the estimate used if no other data is found.

Select Median, Average, or Most Recent amount is used to calculate estimates. Average is the default.

Select the UCR fee percent. The UCR fee is used if no other amounts are available and will need a percentage to use to estimate coverage. For example, if you are charging $100 for a procedure, the insurance coverage level for that procedure is set to 80%, and the UCR fee percent here is set to 80%, the treatment plan would show an insurance estimate of $64.

NOTE: If you’d like to send anonymous fee information to Open Dental to help us improve this feature in future versions, please check to allow anonymous fee sharing. Only fee information will be sent.

Set up Manual Blue Book fee schedules

Go to Lists > Procedure Codes > Fee Schedules. Once Blue Book is enabled, Out of Network Fee Schedules will no longer be used.

If insurance provides a fee schedule with allowed amounts, enter them in a Manual Blue Book Fee Schedule. Only known amounts should be entered.

If you already had Out of Network fee schedules created, you will need to create Manual Blue Book Fee Schedules and copy the out-of-network fee schedule information into them.

Set the correct plan type and link the fee schedule

Make sure the insurance type is set to Category Percentage, and link the Manual Blue Book fee schedule, as shown below. If an Out of Network fee schedule had previously been linked to a plan, you will now need to link the new Manual Blue Book fee schedule under Carrier Allowed Amounts.

Use Blue Book Log to see insurance estimate detail

Take these steps to see more detail on how the insurance estimate was calculated.

1. Open the procedure.
2. In the ‘Insurance Estimates and Payments’ grid, double-click on the estimate.
   
3. In the Edit Claim Procedure window, click the Blue Book Log button.
4. You will see the insurance estimate, and what rule was used for the calculation.
   

Enter allowed amounts when receiving insurance payments

Create and send your claim as usual. When Receiving a Claim, click to Enter Payment ‘By Procedure’, then be sure to enter the Allowed amount as well as the insurance payment amount. The Allowed amount entered here will update the linked Manual Blue Book fee schedule, so future estimates will be more accurate.

If you have questions about this feature or anything else in Open Dental, our support technicians are here to help.