Managing Patient Benefits in Eaglesoft



This post is a follow-up to one I originally posted in January 2013 titled Fee Schedules and Coverage Books. Please check it out if you haven’t done so already. It received a lot of positive feedback and numerous comments so I thought now would be the perfect time to revisit the topic.

A few reasons come to mind as to why now is the best time to readdress:

1) I can’t go wrong with this topic or talk about it too much! I just returned from the CDA convention in San Francisco, CA, where I had the opportunity to speak with loads of existing users. Almost everyone had a question about the best ways to accurately estimate insurance and track patient benefits.

2) Most of you are getting ready to send your end of year benefit reminder letters out. Wouldn’t it be nice to send accurate benefit information (as close as possible) along with it?

3) Automation is becoming more and more popular and is almost a necessity nowadays. Take advantage of automating things like treatment plan follow-ups and insurance/flex spending letters and rest assured knowing you’ve got accurate insurance details for your patients.

Most offices want to make every effort to maintain accurate benefit information and do their best to estimate as closely as possible. Doing so helps to ensure you are collecting enough from the patient up front as well as instilling trust between you and your patients. There is nothing worse than not estimating correctly up front and having to go back and ask your patient for more money after the fact. It’s not fun for you and it’s not fun for your patients. With some effort, you can build better estimates and streamline the walkout and treatment planning process.

Here are my recommendations:

  • Determine if you will be posting at full fee (use Coverage Books) or at insurance fee (use Fee Schedules) and get those set up in Eaglesoft. If you need help determining which option is best for your practice, I suggest reading To Post at Full Fee or at Insurance Fee – That Is the Question. Vicki Mavros from Jameson Management did a great job explaining your options. If you decide to post at insurance fee, Eaglesoft has a preference that allows you to submit your full fee on the insurance claim. More detailed information on Fee Schedules vs. Coverage Books in Eaglesoft can be found on FAQ 20376.
  • Coverage Books are also very useful for accurately estimating benefits for plans you are not contracted with as well as any rule exceptions (i.e., posterior composite downgraded to amalgam). Learn more here: FAQ 12769.
  • Consider enrolling in Real-Time Eligibility to get the most up-to-date and patient-specific insurance information electronically without ever picking up the phone.
  • Evaluate your standard fees and your fee schedules if you haven’t done so recently. Patterson can help with a free limited fee analysis report.
  • Use RevenueWell to set up automated treatment plan follow-ups and insurance letters. This is a great way to improve efficiencies and add value to your practice.

I sincerely hope this information helps you to better manage insurance and patient benefit information in your office. As always, our support team will be available to assist you with any questions or concerns. We also have a team of amazing trainers who are available to come onsite.

3 comments on “Managing Patient Benefits in Eaglesoft

  1. Hello,
    Reference: Real Time Eligibility. Just wanted to input.

    We are not able to use Real Time Eligibility for all insurance carriers…. That makes it difficult…
    Sometimes the Real Time Eligibility information does not match with benefit information on line.
    Also, if someone has an Aetna Dmo product, the information comes through as out of network info. Staff has a hard time knowing the difference.

    Thank you,

    Elaine

  2. Elaine and Purvi,
    Please call 1-800-475-5036 and ask to speak with one of our eService support specialists. They will be best able to help you with these issues.
    Thank you ~

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