Setup Insurance Categories
Insurance categories allow automatic calculations of insurance coverage based on the procedure code.
Do not alter insurance categories unless you understand what you are doing. Some changes affect Benefit Information for ALL insurance plans. The only known reason to change insurance categories is if you are in a country other than the United States.
In the Main Menu, click Setup, Family/Insurance, Insurance Categories.
Coverage Categories: Coverage categories have specific procedure code spans attached according to typical insurance groupings. Categories are used to calculate the actual insurance coverage for specific procedures. The categories that exist affect the categories available when creating a Benefit.
Description: The category name.
Coverage categories are completely unrelated to procedure code categories in Definitions.
Coverage Spans: Each coverage category can have unlimited spans of procedure codes attached. The default spans should work for most offices. Adding extra spans does not increase complexity for the staff. They will still only see the coverage categories set up. Spans simply allow you to put whatever procedures you want into each category. A span can be as short as a single code. Spans can be deleted although this will affect patient data if the span includes a patient's procedure (it does not corrupt the data). Changes to spans will affect the treatment plans of multiple patients.
To add a coverage span, click Add Span, or double click a coverage span row to edit.
Open Dental warns you if the code is not in the correct ADA format (at least the first 5 digits), but you can still use such codes if you wish.
If you have a category that is a subset of another span, then that category should be lower in the list.
Frequently Asked Questions
Question: Why is there no category for implant services (codes D6000-D6199)?
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