Setting Up Insurance Schedules

An insurance schedule is a schedule of benefits offered by an insurance plan. You can set up and customize insurance schedules to provide accurate benefits to your patients and ensure precise billing for your practice. AcuityLogic includes a default version of each insurance schedule. For each insurance plan that your office uses, make sure that the receivable for each item type is correct, as the receivable varies depending on a company’s contract with each insurance carrier.

You can create multiple insurance schedules for each plan. Each different insurance schedule for a plan is called a version. Having multiple versions allows you to assign a different schedule to different office locations, if needed. It also allows you to set up new insurance schedules ahead of time if you know that a plan’s benefits will be changing. For example, if the benefits for the plan VSP Choice will be changing on January 1, you can set up the new insurance schedule in September and choose for the new schedule to automatically start and the older schedule to automatically end on January 1.

This section explains how to set up insurance schedules.

Topics include the following:

  1. Open the Insurance Mapping window. See Opening the Insurance Mapping window.
  2. To search for a specific insurance carrier, select a carrier or enter the carrier name in the Carrier Name drop-down list and click Find.
  3. Click the Plans link for a carrier to view all plans available for the carrier.

    The Insurance Plan Mapping window opens.

  4. To search for a specific plan, select a plan or type the plan name in the Plan Name drop-down list and click Find.
  5. Click the Add Schedule link next to the plan.
  6. In the Add Schedule window, select Create blank schedule from the Copy/Create drop-down list.
  7. Click Next.

    The Insurance Schedule Version window opens and a version number is automatically assigned to the schedule.

  8. To modify the schedule by setting up detailed benefit information, see To modify insurance schedules.
  1. Open the Insurance Mapping window. See Opening the Insurance Mapping window.
  2. To search for a specific insurance carrier, select a carrier or enter the carrier name in the Carrier Name drop-down list and click Find.
  3. Click the Plans link for a carrier to view all plans available for the carrier.

    The Insurance Plan Mapping window opens.

  4. To search for a specific plan, select a plan or type the plan name in the Plan Name drop-down list and click Find.
  5. Click the Add Schedule link next to the plan.
  6. Select one of the following options from the Copy/Create drop-down list:
    • To copy a schedule from any plan, select Copy from any plan, and go to step 7.
    • To copy a schedule from the same plan, select Copy from another schedule within this plan, and go to step 9.

  7. Select an insurance carrier from the Carrier Name drop-down list.

  8. Select an insurance plan from the Plan Name drop-down list.
  9. Select the item types to copy by following the methods below:
    • Select the check box for each item type that you want to copy.
    • To select all item types, click All.
    • To deselect all item types, click None.
  10. Enter or select the schedule start and end dates in the Start Date and Termination Date fields.
    You are required to record schedule start and end dates. If you record a start date in the future, you will not be able to use the insurance plan schedule until the start date. Although you can assign multiple versions of an insurance schedule to an office, the insurance schedules’ start dates and termination dates cannot overlap.
  11. Click the link for the schedule version from which you are copying item types.

    The Insurance Schedule Version window opens and a version number is automatically assigned to the schedule.

  12. To modify the schedule by setting up detailed benefit information, see To modify insurance schedules.
  1. In the Insurance Schedule Version window, enter or select the schedule start and end dates in the Start Date and Termination Date fields, if necessary.
    You are required to record schedule start and end dates. If you record a start date in the future, you will not be able to use the insurance plan schedule until the start date. Although you can assign multiple versions of an insurance schedule to an office, the insurance schedules’ start dates and termination dates cannot overlap.
  2. To add or edit a method, follow the instructions below:
    1. Select an item type from the Item Type drop-down list, and then click the Add button that displays.

      OR

      Click an item name in the Item Name column.

      The Edit Schedule Item window opens.

    2. Select an item group or item name from the Item Group and Item Name drop-down lists, if you are adding an item.
      You cannot edit the item group and item name if you are editing an existing method.
    3. If you are setting up a method for eyeglass lenses (for example, lens base type, material addon, tint, etc.), select a base lens from the Base Lens drop-down list.
    4. If you are setting up a method for frames, and if the method is only applicable to a specific price range, type the minimum and maximum dollar amount of the eligible frames in the Min Amount and Max Amount fields. If the method is applicable to all frames, regardless of price, leave the Min Amount and Max Amount fields blank.
      If the plan offers different benefits for multiple price ranges of frames, set up a separate method for each price range. For example, you can set up one method for frames priced $50-$100, and another method for frames priced $101-$200.
    5. Select a method from the Method drop-down list. See Insurance Schedule Methods.
    6. Select a Calculation Type for the displayed Method Components and type an Amount for the Calculation Type, if necessary. You do not have to select an amount for each Calculation Type. See Insurance Schedule Method Components.
    7. To view the method details, click Show Methods.
    8. The method details display.
    9. Click Save.

      Edited data is highlighted in the Insurance Schedule window and the Action column indicates an Update for the item.

      New schedule items are listed and highlighted for Add in the Action column.

  3. Repeat step 2 for each method you need to set up for the insurance plan.
  4. To edit an existing method directly in the Insurance Schedule window (without opening the Edit Schedule window), enter amounts in the Allowance, Receivable, Copay, and Discount fields.

    Changed amounts are highlighted. All changes made in the Insurance Schedule window are highlighted in the Action column.

    You can only edit the fields that display fields.
  5. To delete a schedule item, click the Remove icon () for that item , and then click OK.

    The deleted Item Name is grayed out. In the Action column, the change is highlighted as DELETE.

  6. To save all of your changes and close the Insurance Schedule window, click Save & Return.
    If you do not click Save & Return (or Save), some changes made to the schedule may not be saved.
  7. To save your changes and continue making changes to this insurance schedule, click Save.

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