Payment Base
The Payment Base indicates whether an insurance plan is operating on a UCR percentage or a pre-set Benefit Schedule. UCR stands for Usual, Customary, and Reasonable. The insurance carrier will pay a set percentage for Preventive, Basic, and Major procedures based upon whatever your office fees are, as long as they are "reasonable" fees. If a Benefit Schedule is used, the carrier should supply you with a listing of benefits indicating what the benefit is per procedure code. These benefits are usually listed in the form of a published Benefit Schedule. In this case your office fee is not a consideration unless the benefit is larger than your fee. In that case the benefit will be reduced to equal your fee. This glorious anomaly doesn't happen very often.

UCR Rate Coverage
If the Payment Base is UCR then enter the appropriate percentages for Preventive, Basic, and Major procedures. Some insurance carriers consider Single Crowns (free-standing, not part of a bridge) to be Basic procedures and others consider them as Major. Indicate Basic or Major in the Single Crown field. Likewise, Perio, Endo, and Oral Surgery category procedures can be indicated to be calculated at either a Basic or Major percentage.

Schedule Of Benefits
If you select Schedule Of Benefits the Create Schedule button to the right of the Payment Base option will become enabled (functional). Click on this button to create a benefit schedule for this benefit plan. After clicking on the Create Schedule button, the button changes to Edit Schedule. So far a benefit schedule has been created, but all values are initially set to zero. To actually enter the fees, click on the Edit Schedule button. This will open the Fee Schedule Entry screen. Use this screen to enter the schedule of benefits for this Benefit Plan. The benefit schedule name will appear on the screen. The name will consist of the Benefit Plan name plus an underscore followed by a unique number. This number is the ID number assigned to each Benefit Plan and will be unique for each plan. After clicking on the Create Schedule button it changes to Edit Schedule as already mentioned. At the same time the previously disabled Delete Schedule button also becomes enabled. Once a benefit schedule is created it can also be deleted.

If you change the Payment Base of a Benefit Plan to UCR from Schedule Of Benefits, any created benefit schedule will be deleted. You cannot have a benefit schedule for a Benefit Plan using UCR benefits.

Check out the Benefits Remaining Report found on the Insurance Reports menu. This report will give the amount of remaining benefits for insurance patients selected for Automatic Benefit Calculation whose treatment is marked as Not Complete. The Plan Year is also displayed indicating the months these benefits renew. This is useful for getting patients in before their benefits run out.