Insurance – Updating Estimated Insurance
Estimated insurance amounts are updated from the patient’s Transaction screen.
The amount of estimated insurance which is calculated when treatment is entered on a Transaction screen is based on the insurance Global Plan.
MOGO’s Global Plan estimates 100% on preventive, 80% on restorative, and 50% on major work. These estimates should be updated on the patient Transaction screen whenever an insurance payment is entered or when a pre-authorization is received.
You will be asked by MOGO if you would like to update insurance coverage percentage or maximum whenever you link insurance payments to lines of treatment.
- The maximum is the maximum dollar amount that the insurance will pay for this treatment.
- The coverage is the percentage of the treatment fee that the insurance will pay.
When you enter a primary insurance payment and the patient also has secondary insurance, MOGO will ask if you want to update the coverage percentage or maximum for the secondary.
- This will update the S.Cov% or S.Max fields in the Secondary Insurance Plan screen.
- You can view the Secondary Insurance Plan by clicking on the “S” button at the bottom of the Transaction screen.
MOGO will update every patient with the same group number whenever estimated insurance amounts are modified. By modifying benefits for one patient, you have now modified benefits for everyone with the same employer, insurance company, and group number!
Estimated insurance can be also be modified as follows on the Transaction screen:
- Click under the Est. Ins1 column on the same line as the ADA code. You must be on the line where there is an ADA code.
- Type the actual amount the insurance paid for this procedure under the Est. Ins1 column. You can type right over the amount that is shown.
- Press [Enter]
- MOGO will ask if you want to update either the maximum or the coverage percentage.
The insurance plan is now updated to the new estimated insurance amount.
To view the changes to the primary insurance plan:
or
- Click on
in the bottom right corner of the Transaction screen. This will open the Insurance Plan screen. You would click on S for secondary plan information.
The changes that were made will appear in black. The original Global Plan will remain in red for reference purposes.
You can also change estimated insurance amounts by editing the Insurance Plan screen.
Tip: Click on the Printer button at the top of the Insurance Plan screen to print the insurance plan information for the patient.
The patient’s secondary insurance plan can be accessed by clicking on the “S” button.