Canada Insurance Categories
Canadian insurance categories allow automatic calculations of insurance coverage based on the procedure code. Changes affect benefit information for all Canada Insurance Plans.
The insurance categories above are the recommended setup for Canada.
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.
Description: Name of category.
Default Percent: The percentage default for new insurance plans. Changing this number only changes the default value for future insurance plans. It does not affect any patient records.
Is Hidden: Check to hide this category.
Electronic Benefit Category: You must have exactly one of each E-Benefit Category. There can be no duplicates and no missing categories.
Coverage categories are completely unrelated to procedure code categories in Definitions.
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 CDA 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.
To convert the default spans to the recommended set, use the steps below. If you have different spans, these instructions may not be correct.
The resulting insurance category spans will look like this:
As new insurance plans are added, they will only use the new insurance categories. Part A and Part B categories will not be used.
Existing insurance plans will continue to use the old insurance categories and percentages unless the plans are manually edited. To do so, we recommend changing insurance plan Benefit Information via the Insurance Plans (Lists, Insurance Plans) so all subscribers are affected by the change.