Tuesday, January 6, 2015

Delta EPO's and Co-Pay plans, how to setup

Lately I have been seeing a few new insurance plans creeping up in the market. In Colorado, I have seen these new “EPO” Delta Dental plans that have a patient co-pay instead of the traditional coverage %. Then, when I was in Washington recently, the office showed me a plan where the patient pays a total dollar amount on certain procedures. These plans sound similar, but the setup is slightly different.

With the “EPO” plans, I would use the co-pay feature inside of the coverage table. The reason I would use the co-pay is that there is a different patient co-pay for every procedure code. View the image below to see the fields to use for this type of setup.


Then I have seen other plans where the patient pays $65 for the exam, X-rays, prophy, etc., or pays $800 for a crown, but nothing else is covered. In this situation, I would use the Payment Table because there is not a co-pay on every procedure code. Remember, the Payment Table will override the Coverage Table. Set the coverage % to 0 because anything that is not listed on the benefits sheet is not covered. See the image below for the fields to use with this setup.


Dayna Johnson, Certified Dentrix Trainer
Dayna loves her work. She has over 25 years of experience in the dental industry, and she’s passionate about building efficient, consistent, and secure practice management systems. Dayna knows that your entire day revolves around your practice management software—the better you learn to use it, the more productive and stress-free your office will be. In 2016, Dayna founded Novonee ™, The Premier Dentrix Community, to help cultivate Dentrix super-users all over the country. Learn more from Dayna at www.novonee.com and contact Dayna at dayna@novonee.com.