To Set Up a Capitation or PPO Plan
Follow these steps to set up a Managed Care plan:
- Enter Employer/Insurance information in the Patient Information screen in the usual manner.
- Select Capitation Plan in the Employer/Insurance Information screen by clicking on the arrow in the Plan Type field. By selecting “Capitation Plan”, MOGO will track the patient on the Managed Care report, allow you to print a PPO Receipt, and as well as add a UCR% column to the insurance plan window. The Payment Type field will default to Payment to Provider. Note: If you change the Payment Type to Payment to Patient, the insurance portion is shown on the Transaction screen as the patient portion.
- Enter an individual annual coverage amount of $9,999.00 since there is not a maximum yearly coverage. Enter an amount in the deductible field if there is a deductible, or you can enter 0.00 if there is no deductible. Do not leave these fields blank.
- Copy the ADA codes into this insurance plan by clicking on the “Copy Code” button in the insurance plan window. All of your ADA codes will then be copied into this window so that you can edit them. For example, you will want to edit the Fee column to add the fees that are charged for this plan. Only the codes that you edit will be saved to the insurance plan. If you copy codes again into the same insurance plan, it will not overwrite any codes that have already been edited. Tip: You can also copy codes through the Insurance Plan screen from the Transaction screen.
- The deductible column can be filled in manually with either N for “no deductible” or Y for “yes”. If it is left blank, it will assume that the deductible is “No”.
The “Copy Code” button at the top of the Insurance Plan screen will copy all of your usual ADA codes from your Service Code list into the current insurance plan.
Note: After you use the “Copy Code” button and click [OK], you will be in an editing mode. The “Copy Code” and “Copy InsPln” buttons will not be shown at the top of the screen when you are in the editing mode. When you click on the [Done] button, you will once again see the “Copy Code” and “Copy InsPln” buttons.
The “Copy InsPln” button at the top of the Insurance Plan screen allows you to copy an existing insurance plan into the current insurance plan. It does not copy the employer, insurance company name, or group number. It will copy information such as the codes, fees, percentages from one plan to another. This is very useful when you have similar plans since it will save editing time.
Click here to see Examples of Editing Plans.
If you are using the “Copy InsPlan” feature to copy plans from one plan to another plan, you will have several additional options.
MOGO will first let you know that the you are replacing the current plan’s benefit schedule with information from a different plan. The message will say, “You are copying a different type of insurance plan from a different insurance company. Are you sure you want to continue?”
After you click on “Yes” to continue, you will have the following options:
- Copy Entire Plan – This will copy the entire selected insurance plan into the current plan, including fees, maximums, and percentages. This is used when you have capitation plans that are similar. You would then edit the plan as needed.
- Copy specific information from selected plan – When you select this option, you can then mark three additional choices. They are Fee Schedule, Plan Maximums, and Payment Percentages. You can select any combination of these options to copy into the current plan. Options that are not selected are not copied, allowing you to update the fee schedule without modifying the payment percentages. Note: You must have existing fees, plan maximums, or payment percentages in a plan in order to copy in specific choices. For example, you could edit the cap plan fees for one plan and then copy only the fees into other plans.
Note: You must have existing fees (or a zero) under the Fee column before you use the “Copy InsPlan” feature. If the Fee column for a code is blank, the code will be removed when you click on [Done].
If you receive a check every month from the insurance company, you will need to Enter Monthly Capitation Checks.