Diamond Dental Software automatically calculates insurance benefits as you post procedures. Each account has an overall Total Balance and another balance called the Amount Due Now. This Amount Due Now is used to represent the patient portion of charges. During the opening of a new account with insurance, you will be asked the Track Patient Portion question. If you answer No, the Amount Due Now and the Balance simply remain the same. No distinction is made as to the patient’s total balance and the amount you are expecting them to pay now. However, if you answer Yes to the Track Patient Portion question, you are saying that with this account, you will make a distinction between the total balance and the amount the patient is expected to pay. You can review the Track Patient Portion section for a complete discussion on the Track Patient Portion question.

When the Track Patient Portion question is answered Yes, you are indicating that the Amount Due Now will represent the patient portion of charges. You will then be asked if the Benefit Calculation for this account will be Manual or Automatic. Manual Benefit Calculation is discussed in detail in the Track Patient Portion section. If you select Automatic, the program will calculate the benefits for you, providing you give the program the information it needs to do so.

When you select Automatic Benefit Calculation, the Due Now amount will be incremented automatically, according to the benefits that have been entered into the computer for the account. As you post procedures, you will see the computer increase the Due Now amount automatically.

To properly set an account up with Automatic Benefit Calculation, several factors need to be in place:

• You must mark Automatic on the Account Information Entry screen.
• Page 2 of the Benefit Plan record for this account must have the benefits entered which include the Maximum, Deductible, and Payment Base (UCR or Schedule). You also must mark the Benefit Plan as Auto Benefit Ready.
• Each patient has his or her own personal Maximum and Deductible that must be entered. This is seen on the Patient Entry screen.

When opening an account, you will be entering the insurance subscriber’s Maximum and Deductible (among other things) on page 2 of the Benefit Plan screen. When entering patient information on the Patient Entry screen you will enter the patient’s  personal Maximum and Deductible. If the patient has not used any of his or her benefits so far this year, the patient’s Maximum and Deductible will be whatever the Benefit Plan’s Maximum and Deductible is. To enter the values of the Maximum and Deductible from the Benefit Plan record into the patient’s record on the Patient Entry screen, you may either simply type in the values, or click the Reset Prime button (or Reset Second button if secondary), and whatever has been entered in the Benefit Plan will be pasted into the patient’s record. For example, if the patient’s plan has a $1000 Maximum and a $50 Deductible, and no benefits have yet been used this year, enter $1000 and $50 into the patient’s record. If the patient has met his or her deductible and has only $600 remaining in benefits, enter $600 for the maximum and 0 for the deductible. These values will be used for this patient for the remainder of the benefit year. When the new benefit year comes around, the program will refresh the patient’s benefits to $1000 and $50. Benefits will reduce as procedures are posted.