D4W and SADS (EDS/ GDS/ PDS) Insurance Management

Prerequisites

In order for the system to be able to operate as expected the following are needed:

• A copy of the current SADS schedule

• The General Setting Set multiple Insurance Environment must be enabled:

  • Go to Location Setup > General tab

  • Group: Insurance

  • Set multiple Insurance environment = Yes
    
    

Setup specific SADS Item Codes (optional)

Although SADS uses the Australian ADA Item system, some non-standard items may have been added and some items have slightly modified behaviours. These items may need to be added to D4W if those codes are used in treatment cases.

Setup the Insurance Company for SADS

If there is no Insurance Company named SADS, one will need to be created. 

Setup the Plans connected to SADS Insurance

1. To setup the Insurance Plans (one needed for each of the schedules):

   1. Insurance in View: SADS (SA)
      

   2. Insurance Plans section. Click Add
      
      

2. In the Insurance Plan details window:

   1. Find Plan Code: SADS
   2. Plan Name: SADS EDS or SADS GDS or SADS PDS Metro or PDS Country
   3. Click  to enter the New Period Start Date
      1. Click OK
   4. Co-Payment is allowed must be ticked 
   5. Add the rebate fee against each item. See Fee Schedule for SA Dental Pays $ amounts

   6. Click OK

   7. Repeat Steps 2.1 - 2.6 for each plan
      

Setup the new Practice Fee Level for each schedule

A new fee level needs to be created to match the SADS insurance plan created above.

Note: Centaur Software is not responsible for maintaining the fees, please refer to SADS Fee Schedules. 

1. Create the new fee levels if NOT already present

2. Populate the fees with the values from the SADS fee schedule, ensuring that the fee period starts when the new schedule starts (i.e.: 10/07/24)

3. Repeat for each level

Setup the Patient Record

The General Setting Set multiple Insurance Environment must be enabled.

1. Go to Patient Records > Patients tab > Insurance/Various sub-tab

   1. Location Fee Level: SADS - GDS / SADS - EDS / SADS - PDS Metro or SADS - PDS Country

   2. Insurance Level: SADS

   3. Insurance Plan: GDS / EDS / PDS Metro or PDS Country

SADS - EDS: Create Patient Portion Payment

A flat fee applies irrespective of service(s) received under EDS.

Enter the patient portion amount (see EDS fee limits in the schedule) as a Deposit prior to Treatment being performed

Create Co-Payment Invoice

The process is the same as any invoice in the system.

1. Go to Patient Records > Treatment tab

2. Enter item/s 

3. Itemised Invoices menu > Select New Invoice Only/ Press F2 key / Click New Invoice icon

4. Tick Show extended attributes > Tick Auto allocation
   

5. Click OK to the following message
   

6. Click Create or Receive Payment to receive the gap payment

Note: The installment amounts that the system calculated can be changed. Remove the tick on Auto Allocation. Then the Amount boxes in the installment section will be open to editing. Discounts etc. can also be adjusted by this method. This is useful for when the EDS treatment limits have been exceeded

Allocate Patient Portion Payment

For EDS patients, the payment can be received by clicking Receive Payment. Allocate the Deposit to the Invoice. 

Receive SADS Payment 

1. Go to Patients Records > Receipts tab

2. Receipts menu > Select New Receipts...

   1. Payment from select Insurance > SADS

   2. Enter the Amount 

   3. Select the SADS Payment Type 

   4. Ensure the amount is allocated to the correct balance. Remove tick from Autoallocate Payments, then enter the amount against the correct balance if not
      

   5. Click Create /Print 

Printout Formats for Co-Payment Invoices

These printouts need to contain data in respect to the Insurance (SADS) and Patient portions concurrently as shown below: