Open Dental Forum

I would like to discuss the current behavior of the program as relates to child fluoride. Child vs adult fluoride is actually handled in three entirely separate parts of the program:

1. Recall. See the recall types section under setup. Open the child prophy window. As you can see, it automatically uses adult if 12 or older.

2. Manual entry. If not recall, then the user manually enters either adult or child. For example, from the appointment edit window, or in the Chart module.

3. Insurance benefit estimating. Lets you set the age limit for fluoride coverage. The behavior was recently changed in version 6.8 in response to this discussion:
viewtopic.php?f=1&t=2304&p=9446
It only limits estimates for child fluorides, typically at 18 or 19.

So here's my question for everyone. What does everyone think of the current behavior? I think #1 is right because everyone I know bills it as adult if over age 12, but maybe everyone I know is doing it wrong. I think the behavior of #3 is about as good as it's going to get for the reasons explained in that discussion. But #1 and #3 behaviors do not seem to work together well. They are different. So I guess my question is mostly about #1, the recall. If we let users set the age, would a global default age setting be acceptable, or do we need to allow setting it per plan? Also, should we crank up the automation and turn it into an autocode so that the user has to think less about which one to use?

Make it with a global default age in the recall setup, but have it so the plan definition in the family module can override the default. Maybe add something in the plan definition where we can enter the age at which the plan says we should start billing adult fluoride if it is covered.
Jorge Bonilla, DMD

As a soon to be former softdent user I can tell you how they do it. They set up a global age in their version of definitions so the office could pick if they want the age to be 12, 13 or whatever for the cutoff between 1203 and 1204 (also works for 1120 and 1110). Then if you try to post a 1203 on a 60 year old patient a pop up box will tell you that your using the wrong code and ask if you would like the software to change it for you to the correct code automatically.

I think it would be great to not only add the age cutoff for between a 1203 and 1204 into each individual insurance plan but also to have a maximum age set in each plan for the cutoff age that fluoride benefits are paid. There are some plans that cover fluoride on all adults. I would like to see Open Dental be able to estimate benefits on fluoride. Seem silly that an office could forget to stick a tray of goop in an adults mouth for a minute and get $16-$26 dollars with no resistance from the patient since its free to them. Now it would be REALLY sweet if Open Dental could estimate that an adult is too old for fluoride insurance benefits and even know if you are supposed to charge the insurance UCR or your office full fee for the fluoride.

As af as automation is concerned I am in favor of it as long as there is a way to override it for certain plans especially some local union plans that are really not insurance and don't have to register with the states insurance commision and can use their own claim forms, make their own rules etc. and make a rule that all fluorides must use code 1203 to be paid regardless of age. I also ran into that years ago when I took one of my states medicaid plans. They would pay fluoride up to age 21 as long as you used code 1203 and would deny the service if code 1204 was used.

I agree that, if possible, there be a global default that users can choose, then also the ability to override this in the insurance plan. Re: age 12 global default. Kansas Delta, by far the state's major insurer, has set the code change at age 14 regardless of mixed versus adult dentition.

Delta Dental of California is 14 years and younger....in other words, becomes Adult Prophy on 15th birthday.

As I have heard from more users, I'm beginning to think that #3 is also wrong. If there's an age limit on fluoride coverage, that limit needs to apply to BOTH child and adult fluoride. And the age at which child becomes adult is an entirely separate number as we already discussed. I think the way to solve #3 is to add support for code ranges on benefits so that we can put both adult and child age limit within one benefit entry. If you are reading this and don't understand what I'm talking about, then you can ignore it. I'm only providing the high level of detail for a few users out there who will understand.

Issue #3 in this discussion is now feature request #1308.