View Benefit Plan screen – page 1 | page 2 | page 3 , View Video, 2 min. 15 sec.

For every Insurance Subscriber record that you create, you will need to select an Employer record and a Benefit Plan record. The Employer record was discussed in the Insurance Subscriber section. The Benefit Plan record stores the subscriber’s insurance carrier (or more correctly, a reference to it) and some other important items needed to print insurance forms such as the Group Number. In addition, the Benefit Plan record stores insurance benefits which allows the program to keep track of the Patient Portion of the patient’s Balance through the Automatic Benefit Calculation feature.

The Benefit Plan record should be named after the employer. If the employer is Lockheed, then the Benefit Plan shouldl be named Lockheed. Some employers may have more than one plan for their employees. These plans can be quite different. They may even have different insurance carriers and totally different benefits. For example, if Lockheed has different plans for hourly and salaried employees, then you will create two Benefit Plans. One should be named Lockheed Hourly and the other should be named Lockheed Salaried. You will select the Benefit Plan that is appropriate for the particular insurance subscriber.

Selecting the Insurance Subscriber's Benefit Plan
Selecting a Benefit Plan for a subscriber is very similar to selecting the Employer as was discussed in the Insurance Subscriber section. The Benefit Plan is a large record which is displayed over three pages. However, most of the information in this record is optional, except for three items. You must name the Benefit Plan, you need to enter the Group Number, which is a field in the Benefit Plan record, and you need to select an associated insurance carrier for the subscriber. This section will discuss most of the rest of what is contained in the Benefit Plan record, but only the Benefit Plan name, the Group Number, and the insurance carrier selection are required for insurance processing. These items are found on page 1 of the Benefit Plan record.

Items Required For Automatic Benefit Calculation
Diamond Dental Software has the option of automatically calculating the insurance benefit as you post charges into the computer.  The patient portion of charges is displayed as the Amount Due Now.  In order to perform this calculation, the program must store insurance benefit data from the carrier. The Benefit Plan Record is where this information is stored.  These items are found on page 2 of the Benefit Plan Record.

Items Concerning Patient Eligibility For Benefits
Items concerning eligibility are found on page 3 of the Benefit Plan record.  Items, such as the time required between full mouth radiographs, or the amount (in dollars) a claim must be in order to require pre-authorization, are entered here.