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Re-Estimating Insurance for Undated Treatment

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Edit on the menu bar in the Transaction screen has the option to Re-Estimate Insurance Coverage. This will allow you to quickly update the insurance estimates for any undated treatment based on the current insurance plan for this patient.

You will also have the option to update your fees for the undated treatment at the same time you update the insurance estimates.

This feature is very useful since your Treatment Plans may have been entered six months or even one year ago, and the patient has not yet scheduled for the recommended treatment.

When you Re-Estimate Insurance Coverage, you will select lines of undated treatment. This feature will only re-estimate insurance coverage for undated treatment. You can select any undated treatment. It does not have to be a printed Treatment Plan.

Note: If you select treatment that is dated, MOGO will let you know that “Re-Estimate Insurance Coverage can only be done on UNDATED treatment.”

Follow these steps to Re-Estimate Insurance Coverage:

  • Click in the multi-selection boxes to select multiple lines of undated treatment. If you are just selecting one line of undated treatment, you can click anywhere on the line. Note: If you click on a blank line, MOGO will tell you to use the multi-selection boxes.
  • Click on Edit on the menu bar and select Re-Estimate Insurance Coverage.
  • MOGO will ask if you would like any new Fee changes to be included in the re-estimation. Tip: This is very useful if your office fees have increased since the undated treatment was first entered on the Transaction screen.
  • Click on the New Fee button or the Existing Fee button on the message screen. The New Fee button will change the fees based on your current fees in Service Codes. If you click on the Existing Fee button, the fees will not change.

Note: If there are insurance fees under the Fee column in the patient’s Insurance Plan, the re-estimation will ALWAYS pull the current fee for the Insurance Plan even if you click on the Existing Fee button. Fees that are in the patient’s Insurance Plan are used with Managed Care/Capitation plans.

After the re-estimation is completed, MOGO will tell you the following:

  • Total number of lines you selected (since it allows you to select Treatment Plan codes, Silent Codes, undated treatment, dated treatment, etc.)
  • Total number of treatment lines (actual treatment codes, both dated and undated)
  • Total number of undated treatment that was re-estimated (only undated treatment will be re-estimated)

MOGO will save information regarding the re-estimation in the patient’s Notes. It will be saved under the Category of Comment and the Sub-Category of TxPlanReEst.

The patient’s Notes will contain the date, time, and login name of the user who re-estimated the insurance coverage. You will also see the original code, fee, and estimated primary and secondary insurance amounts and the new amounts after the re-estimation was done.

After you Re-Estimate the Insurance Coverage, you will probably want to reprint the Treatment Plan for the patient so that the Treatment Plan Detail window contains current information.

You can click with the right mouse on the Treatment Plan code (TPSnt code) on the Transaction screen and select View Treatment Plan. This will open a Treatment Plan Detail window containing the treatment for the selected Treatment Plan.

  • The Treatment Plan Detail window will list each line of treatment, along with the current Fee for the treatment.
  • The “TPSnt” code on the Transaction screen will always show the original amount under the Fee column from when the Treatment Plan was printed. You will probably want to print a new Treatment Plan for the patient.
  • The Fees may now be different if you updated the fees when Re-Estimate Insurance Coverage was used.

Tip: The Auto Tx Fee Update will allow you to automatically update fees for all incomplete treatment or only for incomplete treatment that meets specific criteria. This is a quick way to update fees for Treatment Plans when you increase your office fees each year.

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