Percentile Reimbursement PPO

Offices that are located in Hawaii may use these plans. If your office is not located in Hawaii DO NOT USE this plan type.

In addition to setting up Standard insurance plans, Capitation plans, and Participating Plan with adjustment, there is also an option to set up Percentile Reimbursement plans. An example of a Percentile Reimbursement plan is when the doctor has agreed to a list of eligible fees for the patient based on the insurance plan they have selected. In addition to a list of eligible fees, there are plan fees for each plan. Each patient on this plan is allowed to select their own coverage percentage. The dental office would then have a Percentile Reimbursement schedule for the plan which would list the eligible fees and the plan fees, as well as the individual patient’s coverage percentage.

You will select Percentile Reimbursement through Employer/Insurance information and then use the Copy Code feature to copy all your dental codes into the patient’s insurance plan window. You can then edit the insurance plan window to enter the eligible fees and the plan fees. The insurance plan window on the patient’s Transaction screen will allow you to enter the patient’s coverage percentage amount.

You only need to enter each individual plan one time. You can then select any coverage percentage amount from the individual patient’s Transaction screen. For example, Plan 75 might allow the employee to select from six different coverage percentage amounts. When you select the coverage percentage amount for the patient, their family members will have the same coverage percentage.