Add a New Insurance Plan – CareStack: User Resource Center

An insurance plan contract is a legal document that specifies the terms and conditions of the coverage provided to the insured individual by the insurance company. It includes details such as the coverage limits, exclusions, deductibles, and premiums. You can have a seamless integration process, allowing efficient management of insurance plans. With Carestack, users can easily track policy details, manage claims, and streamline the entire insurance process.

Watch this video for a quick overview.

To add new insurance plans, perform the steps below:

Navigate to the System Menu > select Practice Settings > Insurance Manager > Plans.

On the Plans page that opens up,

Click + Add New Plan on the top right.

You can choose to Create New Plan or Copy from Existing Plan.
On the Add New Plan, enter information such as Carrier Details and Plan Details.

Note: Once an insurance plan is created, the carrier cannot be changed; however, you can update the carrier's address.

Within Carrier Details, please fill up as required.

Carrier*: Select an existing Carrier Name.
If the insurance carrier has not been added to your system, you can do so by clicking Add New Carrier.

Once you select the Carrier Name, the information will be pre-populated in the Carrier Details section.

Within Plan Details:

Name*: Input the name you will use to identify the plan in the drop-down lists.
Insurance Type*: Choose whether this is a Dental or Medical plan.
Plan Type*: Select whether the plan type is PPO, Indemnity, Discount, HMO, Co-Pay, Medicaid or Medicare.
Employer Insurance: If you would like to tie this plan to an employer, select Yes.
Group No: Enter the group number associated with this insurance plan.
Carrier Type: Select Carrier Type.
Capitation Fee: Enter a Capitation Fee if applicable.

Note: When entering a Group No, if the number is already linked to other plans, a warning will alert you about the duplication. This ensures your data remains clear and organized.

Within Benefit Related Settings:

Plan Reset Date: Enter the date that the carrier resets the deductible and maximum amounts for this plan. Most carriers use January 1st.
- You can set Plan Reset Date to calculate the Fiscal Year as 365 days from that date.
Waiting Period: Enter the waiting period if applicable.
Verified Date: This field is not mandatory. This will be the date the insurance plan has been verified in the system.

Within Fee Related Settings:

Benefits Coordination Method: This option tells CareStack how the plan interacts with other plans when the patient has more than one insurance plan.
Use UCR fees for Patient Fee Estimation: Calculates patient estimate based on UCR and insurance estimate based on fee schedule. Waiting period fees, maxed-out fees, and non-covered code fees will also default to UCR and cannot be edited.
- Select Yes or No as required.
Default setting for altering Total Fees: Select Yes to allow users to change the total fee amount for procedures associated with this plan without utilizing a corresponding adjustment.
Waiting Period Fee: Choose if it is Max Allowable Fee or UCR Fee.
Fee when Benefits max out: Choose if it is Max Allowable Fee or UCR Fee.

Within Claim Related Settings:

Create Claim: Choose Yes if claims should generate on behalf of the patient.
- If a plan has Create Claim set to No, users will be prevented from creating a Pre-Authorization request for the selected code.
Claim Form Type: Choose the claim form type that should be used when billing the carrier.
Auto close claims with zero amount: DMO plans often have claims for $0.00 because many procedures are covered under the capitation umbrella.
- You can choose to automatically close these for this plan independent of the carrier selection.
Modifiers required for claim submission: Select Yes or No as required.

Click Save to finish entering the remaining plan details at a later time.

Click on Mark Insurance as Verified to confirm the information.

Once you complete Add Plan Details, you will be redirected to View Plan Details where you can configure other tabs.

Benefits

Explore this video for an in-depth walkthrough.

To include Benefits details for your plan:

Click Benefits under View Plan Details.
Click Edit.

Enter General Coverage information such as:
- Family Maximum
- Individual Maximum
Family Maximum is set as either Limited, Unlimited or Not Applicable.
Individual Maximum is set as either Unlimited or Limited.

You can select the Family Deductible and Individual Deductible.
Family Deductible and Individual Deductible are set as either Limited or Not Applicable.

Note: The Family Maximums, Individual Maximums, Family Deductible and Individual Deductibles are as defined by the Insurance Plan. If you set it as Limited alone you can enter the value based on the Insurance Plan.

Enter Ortho Coverage information such as:
- Individual Ortho Maximum can be set as either Limited or Not Applicable.
- Individual Ortho Deducible will be pre-populated if the Individual Ortho Maximum is set as Not Applicable.
  - Individual Ortho Deductible can be set as Not Applicable or Applicable if Individual Ortho Maximum is set as Limited.
- Individual Ortho Age Limit will be pre-populated if the Individual Ortho Maximum is set as Not Applicable.
  - Individual Ortho Age Limit can be set as Applicable or Not Applicable if Individual Ortho Maximum is set as Limited.
- Percent Paid at Banding, set the percentage.
- Treatment in Progress Covered can be set as Yes or No.

Payment Cycle can be set as:
- Monthly
- Quarterly
- Half Yearly
- Yearly

Periodic Claims Required can be set as Yes or No.

Enter Benefit Assignment Settings:
- Assign Benefits to Patient can be set as Yes or No.
- Assign Patient Benefits for can be set based on Location, Provider or both.
Enter Plan Notes.
Click Save.

Coverages

Watch this video for a step-by-step explanation.

To include Coverage details to your plan:

Click Coverages under View Plan Details.
Click Edit.

Select the desired Template from the drop down.

In the Coverages Categories section,

Enter the Default Coverage per dental category.
Select Yes or No for Maximums Waived.
Select Yes or No for Deductible Waived.
If required, enter the Waiting Period in Calendar Months, Days ,Weeks or Years.

Click View Codes to view the related Codes, Code Description and CDT Category.
Click Save.
- Click Save for this Plan to apply changes only to this instance, overriding the template mapping.
- Click Save as new template to create a new template and maps this instance to it.

In the Additional Coverage Information section,

Click Edit to update the Additional Coverages Information.

Select the required code from the drop down.
Enter the Default Coverage per dental code.
If required, enter the Waiting Period in Calendar Months, Days ,Weeks or Years.
Select Yes or No for Maximums Waived.
Select Yes or No for Deductible Waived.

Click + Add Code to add a new code.
Click Save.

Missing Tooth Clause

Explore this video for a thorough walkthrough.

To include Missing Tooth Clause details to your plan:

Click Missing Tooth Clause under View Plan Details.
Click Edit.

Select the Clause from the following options.
- No missing tooth clause
- No coverage until after [enter number] months (Specify the number of months in place of [enter number])
- Not covered for life of policy
- Not covered for congenitally missing tooth
Click Save.

Alternative Benefits

Watch this video for a quick walkthrough.

To include Alternative Benefits details to your plan:

Click Alternative Benefits under View Plan Details.
Click Edit.

Select the desired Template from the drop down.

To add an AMB Code,

Click + Add AMB Code on the top right.

Select the alternative Treatment Code you want to apply against the treatment code.

Select Alternate Benefits.
- Choose a preset from the Select Teeth Preset.
- Select the Teeth from the tooth selector.
- Click Apply.

Click + Add Rule to apply a certain treatment code for the tooth.
Click Save.
- Click Save for this Plan to apply changes only to this instance and removes template mapping.
- Click Update template to update the existing template with any changes, impacting all linked instances.
- Click Save as new template to create a new template and map this instance to it.

Pre-Authorization Codes

Watch this video for a concise summary.

To include Pre-Authorization Codes details to your plan:

Click Pre-Authorization Codes under View Plan Details.
Click Edit.

Select the desired Template.
Select the codes and click the right arrow mark to move the codes from Available Codes to Selected Codes sections.
Click Save.