Insurance Payment Plans

Insurance Payment Plans can be used to track expected insurance payments (e.g. insurance installment payments).

In the Account Module Payment Plans grid, they show with a Type "Ins".

Note:

For example, insurance may pay $1000 towards orthodontics, but pay it in four installments of $250 each. Tracking expected insurance payments is especially useful in orthodontics. The outstanding balance of procedures sent to insurance will be removed from the patient's ledger so the patient doesn't appear to owe money on those procedures. Insurance payments for those procedures also do not appear in the patient ledger (otherwise the patient would end up with a negative balance). Close payment plans no longer being paid on. Any difference between the outstanding pay plan charge and the amount insurance paid is moved to the patient ledger, making the patient responsible for any remaining balance.

General Steps:

  1. Create and send the claim. Each claim can only be associated with a single payment plan.
  2. When the first insurance payment arrives, set up the insurance payment plan.
  3. Receive and finalize the first insurance claim payment. See Finalize Insurance Payment. To receive a claim payment with interest, see Interest on Insurance Payments.
  4. As you receive additional payments, add Supplemental Insurance Payments for the payment amount.
Note:
  • As long as the patient on the claim matches the patient on the payment plan, and the payment plan has a balance, the payment will automatically attach to the payment plan.
  • Run the Insurance Payment Plans Past Due Report to view patients with insurance payment plan amounts past due.
  • Due Now column in Payment Plan grid is for patient due amounts and does not apply to Insurance Payments due.


Set up the Insurance Payment Plan

When you receive the first insurance payment and EOB, set up the insurance payment plan.

Select the patient. In the Account Module, click Payment Plan, Insurance Payment Plan.

Category: Assign a category to this payment plan (e.g. Ortho, Implant). Useful to distinguish one payment plan from another when families have many plans. Customize category options in Definitions: Payment Plan Categories.

Patient: The person who was treated. Click Go To to switch to their account. Patients can have multiple payment plans, and each plan can have a different guarantor.

Provider: Verify the provider.

Clinic: If using clinics, verify the clinic.

Insurance Plan: Click Change, select the insurance plan this payment plan is for, then click OK.

Date of Agreement: Defaults to today's date.

Terms that affect the Amortization schedule.

Create Schedule: Click to create the amortization schedule.

Tx Completed Amt: Enter the total amount of all insurance payments. This is the amount that will be subtracted from the patient's account balance.

Click OK to save the plan.

Note:
  • If, for some reason, insurance pays less than originally stated, you have two options. 1) Adjust the Tx Completed Amt in the payment plan to transfer any remaining due amounts to the patient. 2) Add a payment plan adjustment to discount remaining due amounts. The Total Amount and Total Tx Amt will automatically adjust for the discount.
  • To track insurance payments for procedures on multiple claims, create a payment plan for each claim.
  • This method does not work when the Paysplits preference is set to Rigorous, in Allocations Setup.

Attaching/Detaching Payments to or from Plans: If you create the claim payment before you create the insurance payment plan, the payment will not automatically attach to the payment plan. To manually attach, open the claim payment, double-click the procedure to open the Claim Procedures ( claimprocs ) window, then check Attached to Insurance Payment Plan.

To detach a payment from an insurance payment plan, open claim, double-click the procedure to open the Claim Procedure window, then uncheck Attached to Insurance Payment Plan.

Troubleshooting

When entering the insurance payment, it does not automatically attach to the payment plan even though there is a balance on the plan.