Over the last few versions of Open Dental, we’ve implemented a new feature called Code Groups. These allow for more flexibility and customization of Frequency Limitations and Age Limits in insurance plans. In today’s post, we’ll review the Code Groups and setting up benefits, so you’re prepared when setting up new insurance plans or editing existing plans.
Code Groups
Code Groups Setup
Code Groups are lists of procedure codes that are used for Frequency Limitations and Age Limits. Code Groups are entirely customizable. These replace the Frequency Limitations preference found in older versions of Open Dental and Fluoride and Sealant Through Ages (in Edit Insurance Plan).
Code Groups can be found under Setup, Code Groups. In this window we can view and edit existing Code Groups (there are Code Groups set up by default) and create new Code Groups. We can also see if a Code Group will be displayed in the Frequency Limitation Benefits or Age Limits sections in the Edit Benefits window based on the Freq and Age columns.
If you created Frequency Limitations or Age Limits on an insurance plan in an older version of Open Dental (before Code Groups), these benefits will still exist and do not need to be re-entered.
Code Groups Edit
Code Group details can be edited in the Code Group Edit window. For a new Code Group, click Add on the Code Groups window. To edit an existing Code Group, double-click it from the Code Groups window.
Once you update to a version with Code Groups, default Code Groups are created. These may differ from what was set up in Frequency Limitation Preferences. Review the Proc Codes assigned to each group and edit as needed.
You can choose if the Code Group applies to Age Limits, Frequency Limitations, or both. This will affect which Code Groups are shown in the Frequency Limitations Benefits grid and Age Limits grid in the Edit Benefits window.
Each Code Group can also be assigned a Fixed Group. Fixed Groups are used for defined fields like Sheet Static Text Fields like dateLastProphy or dateLastSRP. Each Fixed Group can only be assigned to one Code Group. If you’d like to assign a Fixed Group to a different Code Group, first unassign it from the current group (i.e., set the current group to None).
To add procedure codes to a Code Group, click Add, and the Procedure Codes window will appear to select the desired procedure code. Codes can also be manually typed into the Proc Codes box. Both standard (e.g., D0120) and non-standard codes (e.g., D0120.1) are permitted.
Edit Benefits
The Edit Benefits window has been updated to accommodate Code Groups. There is a grid for Age Limits (this replaces the Fluoride and Sealant Through Ages) and a grid for Frequency Limitation Benefits.
The Frequency Limitation Benefits can now be viewed and edited directly from the Edit Benefit window. Any Code Groups your office has created are listed. Enter Frequency Limitation Benefits by typing a value in the # column, selecting a frequency type from the Frequency column, and selecting a relevant treatment area from the Treat Area column for the corresponding Code Group.
If there are multiple benefits for a Code Group (e.g., Fillings), click the Add button below the Frequency Limitation Benefits grid and enter details.
Any Frequency Limitations or Age Limits that are added to the plan will appear in the Insurance Plan grid in the Family Module for quick reference.
How Does it Work?
Once set up Age Limits and Frequency Limitations are reflected in insurance estimates.
Procedures will be considered towards a Frequency Limitation if they are currently treatment planned or have been received on an insurance claim. Procedures not attached to an insurance claim or outstanding procedures attached to claims are not counted toward Frequency Limitations.
If you have any questions, make sure to reach out to our friendly Support Team.
Information in this post reflects features available in Open Dental Version 24.1. For the most up-to-date information, please visit our manual.