💡 Top tip: When adding or editing a plan, if the insurance carrier and group/plan number exactly match another existing plan, you will see a warning encouraging you to review each affected plan to check whether the similarities are intentional. This will help to avoid accidental duplicates. If both plans are valid, we recommend using the 'Plan identifier' field to distinguish between them.
How do I create a new insurance plan?
📝 Please note: To add a new insurance plan, you must have Level 4 permissions.
Navigate to your insurance settings, then select the 'Insurance plans' tab.
Click '+ New plan' in the top right corner to create a new plan, or you can duplicate an existing plan if needed.
Under 'Plan details', complete the fields as needed:
'Insurance carrier' - Select from your available carriers in the dropdown. This field is compulsory. If your required carrier is missing from the list, add a new carrier before proceeding.
'Group or plan number' - Enter the assigned number for the plan. This number may be shared across multiple plans for the same carrier - use the ‘Plan identifier’ field to differentiate them. This field is compulsory.
'Employer' - Add the employer associated with the plan if applicable.
'Plan identifier' - Use this field to prevent duplicates and distinguish the plan from others with the same or similar group/plan number and insurance carrier. This number is for internal use only.
'Division number' - Enter the division number if applicable.
'Fee schedule' - Select from your available fee schedules in the dropdown. You can add a new fee schedule before proceeding if needed.
📝 Please note: Allowances are tracked at the patient policy level, and automatically adjust based on Explanation of Benefits (EOBs) received.
Under 'Plan coverage', set up plan coverage by entering details for each treatment type:
Add the coverage, allowance limits and scaling units for the plan.
'Basic', 'Major' and 'Ortho' - Define coverage percentages and allowance limits. Orthodontic allowance has a lifetime limit.
After defining plan coverage, you can adjust coverage for specific treatments. There will be a predefined list of treatment ranges, which you can customise or add to.
Edit or delete items using the 🖊️ edit or 🗑️ delete icons to the right of the item.
Add a new code or range by clicking the '+ Add' button at the top right of the table.
Adjust coverage percentages or limits for specific treatments where needed.
When you have completed all the fields, click 'Save' in the top right corner of the screen.
📝 Please note: We are bringing improvements to plan details. If you are on the Beta trial, you can:
Add scaling units - Specify the number of units covered for preventative care. These will reset upon policy renewal.
Add notes to the plan - Include special conditions such as preauthorisation requirements or exclusions.
Set treatment frequency limitations and define the benefit period - choose from rolling (eg 1 exam every 6 months) or fixed (eg 1 exam within the policy dates). When a claim is submitted for a treatment with a defined frequency limit, Dentally will automatically track and update the patient's remaining eligibility.
Use the star icon - Choose which treatment frequency limitations you want to track at the patient policy level.
If you can't see these new features yet, you will do soon. Want to join the Beta trial? Reach out via Support Chat!
How do I edit or delete an existing insurance plan? ✅
💡 Top tip: If you edit an existing insurance plan, the changes will apply to all patient policies where that plan is assigned. Please review the impacted policies and patients carefully before proceeding.
Navigate to your insurance settings, then select the 'Insurance plans' tab.
You will see a list of all your insurance plans. Identify the plan you wish to edit, by scrolling or by using the search bar at the top.
To the far right of the relevant plan, click the pencil 📝 icon to open that plan.
From here you can edit the plan as you would if it was a new plan. You can also duplicate the plan from here if needed.
You will see a warning at the top of the screen if this plan is associated with one or more patients.
You may also see a warning if your plan has the same insurance carrier and group/plan number as another plan. This will alert you to check they aren't duplicates in error. If both plans are valid, please consider using the plan identifier so your team can easily tell them apart.
When you have finished editing, ensure you click 'Save' in the top right corner to store your changes.
When viewing the list of all insurance plans, you can archive or delete any plan by clicking the folder icon 🗂️ or the bin icon 🗑️ to the far right of the chosen plan. You will see a warning alerting you if that plan is currently being used by one or more patients.
How do I duplicate an existing insurance plan? ✅
Navigate to your insurance settings, then select the 'Insurance plans' tab.
You will see a list of all your insurance plans. Identify the plan you wish to edit, by scrolling or by using the search bar at the top.
Click the relevant plan (or click the 📝 pencil icon to the far right) to open that plan.
Click 'Duplicate' in the top right corner.
This will generate a new plan, with the fields auto-populated to exactly match the original plan you duplicated.
Edit any fields if needed, as you would if it was a new plan. You can use the 'Plan identifier' field to help your team quickly recognise and differentiate between duplicated plans which have similar details.
When you are ready, click 'Save'.