Capitation/PPO Plans (Managed Care)

A patient’s Insurance Plan can be edited by selecting their name on the Patient Lookup and clicking on GoTo on the menu bar. Select either Primary or Secondary Insurance Plan. This can also be done from their Patient Information screen. The patient’s Insurance Plan can be also be edited from their Transaction screen.

If a patient has a Managed Care plan, the fee that is charged for this plan is entered in the individual Insurance Plan under the Fee column. You will copy your entire ADA code list into the Insurance Plan screen. Then you will enter the fee for each service in the individual Insurance Plan screen.

Tip: MOGO also gives you the ability to copy an entire capitation plan, or only specific information from that plan, into another capitation plan. This will be very useful when the plan increases their fees at the beginning of the year!

You will also have the option to enter a UCR%, which is a percentage of the doctor’s usual fee. This amount will be added to the patient’s co-payment. Note: The UCR% column will not appear in the insurance plan window unless you have selected Capitation Plan in the Employer/Insurance Information screen in the Plan Type field.

The Managed Care Report can be generated which will contain information regarding these plans, such as the amounts of your usual fee versus the amount that was charged to these patients. This report will be helpful in determining the benefits of various Managed Care plans.

In addition, the patients who are assigned capitation plans can receive a special Receipt that will show them your usual office fee and the amount the patient has saved with this plan. Note: The fee on the Transaction screen is the plan fee.

• The information on the Receipt is based on the information in the patient’s insurance plan.
• The Reg.Charges field on the Receipt is the office’s usual fee for this service.
• The Co-Pay field on the Receipt is the amount the patient has to pay (if any)
• The Savings field on the Receipt is the difference between the office’s usual fee and the co-pay. It is the savings to the patient, not to the office!
• Since this Receipt is in a set format, the options to Include Tooth Number/Surface and Insurance Information cannot be used.

More:

To Set up a Capitation or PPO Plan
Examples of Editing Plans
Entering Monthly Capitation Checks