Using Blue Books

When you define an insurance plan, you will be asked if you would like to use Blue Book values. Blue Book values are an alternative to having the system calculate the insurance payment by taking a percentage of your customary charge. If you choose to use Blue Book values, the system will keep in memory what the insurance plan has paid on procedures in the past and will use this value as its insurance payment estimate.
Defining an Insurance Plan to Use Blue Books
When you enter a procedure for a patient who has not satisfied his deductible, the normal Blue Book value does not apply so the system reverts to calculating the insurance estimate by percentage. Therefore, you must fill out the entire insurance plan as if you were not going to use Blue Book values.

NOTE: DO NOT set any of the percentage rates to 0%. If you set a percentage to 0%, the system assumes that class of procedure is not covered by the plan and will not use the Blue Book values.

Make sure the Use Blue Book for Insurance Estimate box is checked. When you are through entering this record, the system will create a fee schedule for this insurance plan calculating its initial Blue Book values based upon the percentages you have entered for the different types of procedures.

If you have a better estimate as to what the insurance will pay on specific procedures, you can use Edit Fee Schedules to manually enter the Blue Book values you would like the system to use.

Updating Blue Book Values
The "official" Blue Book values are established and kept up-to-date as a normal part of the insurance response system.

When you enter Insurance Payment (procedure code 15) or Insurance Denied (procedure code 16) at the Family Ledger, the system displays the insurance disposal window. This lists the procedures that are outstanding for insurance payment so you can mark the appropriate ones disposed.

When you mark a procedure disposed, the system will check to see if this plan has been set to use Blue Book values. If it has, the system displays the current Blue Book value for the procedure on the screen. If the insurance is paying a different amount and the amount being paid has not been affected by something specific to the patient (such as a deductible or maximum coverage), type in the new value. Otherwise, click Cancel to leave the Blue Book value alone.

The new Blue Book value will be used as the insurance estimate when you enter this procedure in the future for patients who have the same insurance plan.

If you have purchased the Treatment Plan option and would like to record the carrier's response to a pre-authorization, go to the patient's Treatment Plan, right-click the desired transaction, and mark the procedure either accepted or denied.

If you have asked the system to use Blue Book values to estimate the insurance payment from this plan, the system displays the current Blue Book value for this procedure. If the insurance is paying a different amount than is reflected as the Blue Book value and the amount being paid has not been affected by something specific to the patient (such as a deductible or maximum coverage), enter that amount. The new Blue Book value will be used as the insurance estimate when you enter this procedure in the future for patients who have the same insurance plan.

Whenever you get information on the amount a plan will pay for a procedure, use Edit Fee Schedules to enter new Blue Book values.