In Version 23.2 of Open Dental, Frequency Limitations have been overhauled to allow for more flexibility and customization. With this overhaul though, also comes some big changes to how Frequency Limitations are set up. In today’s post, we’ll review the new process, so you’re prepared when setting up new insurance plans or editing existing plans.
First, let’s review the big change. Procedure codes for Frequency Limitations are no longer set up in Preferences, but rather, in the new Code Groups feature. Whereas the preference categories were static (i.e., you couldn’t create new ones), Code Groups are entirely customizable. We’ll get into more detail about these a bit later.
Setting up Frequency Limitations in an insurance plan has also changed. The Benefit Frequencies window has a new look to accommodate Code Groups. Don’t worry, any Frequencies Limitations that were entered in the old window still exist, and won’t need to be re-entered.
As we mentioned above, Code Groups have replaced the Frequency Limitations preference. (NOTE: This does not replace Discount Plan Frequency Limitations). Default procedures are added to Code Groups when you update to version 23.2, but they may differ from what was set up in Frequency Limitation Preferences if your office had customized these, so take a look at the Proc Codes assigned to each group and double-click a group to edit as needed.
Each Code Group can also be assigned a Fixed Group. Fixed Groups are used for defined fields like the BWs, Exam, Pano/FMX fields in the Edit Benefits window or 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).
If you want to create an entirely new Code Group, click Add then enter the details for the Code Group. Both standard (e.g., D0120) and non-standard codes (e.g., D0120.1) are permitted.
Edit Benefits – Benefit Frequencies
This part may be somewhat familiar, but the interface has changed a bit. The old Benefit Frequencies window with preset categories has been replaced with a new Benefit Frequencies window that can accommodate all the custom Code Groups your office makes.
From the Edit Benefits window, click More
The Benefit Frequencies window will open. Any Code Groups your office has created are listed. Enter Benefit Frequencies by typing a value in the # column and selecting a frequency type from the Frequency column for the corresponding Code Group.
These Frequency Limitations will appear in the Insurance Plan grid in the Family Module for quick reference.
How Do Custom Frequency Limitations Work?
Once set up, Frequency Limitations entered using Code Groups work just the same way as those that were added in the old Frequency Limitations preferences. In the Treatment Plan, if a patient has met (or exceeded) their Frequency Limitation for a procedure, Frequency Limitation is noted in the procedure description and estimates are updated accordingly.
Procedures will be considered towards the 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.
Changes to Frequency Limitation setup now allow for full customization, allowing your staff to further streamline your practice’s insurance billing. If you have any questions, make sure to reach out to our friendly Support Team.