How to Enter a Copay-Based Plan (HMO/DHMO)

Setting up a copay-based plan like an HMO or DHMO ensures your practice manages fees accurately for patients with these insurance types. Follow these steps to create and attach a fee schedule, set up a new plan, and assign the correct copay amounts.

Create the Fee Schedule

Go to Settings.

Click Insurance.

Select Fee Schedules.

Click the Plus (+) button in the upper right corner to create a new fee schedule.

Name your fee schedule.

Set the fee schedule type to Fee Schedule.

Attach the appropriate providers for this fee schedule.

Attach relevant insurance carriers.

Select an Effective Date.

Set the plan as In Network. HMO and DHMO plans usually require in-network status.

Click Create.

Enter the specific copay amounts for each procedure code. For example, resin-based composites for posterior teeth (D2391–D2394) each get their set copay as listed by the plan.

Here is an example of a copay-based fee schedule.

Enter each of the fees from the fee schedule in the New Fee Column.

After entering all fees, click Save.

Create the Insurance Plan

Go to your patient's insurance profile and add a New Plan by clicking the blue + icon.

Enter all required subscriber information. (Insurance Carrier, Subscriber ID, Eligibility Start Date)

Click Save and then Next.

Begin creating the new plan.

Enter the group number and all additional plan details.

For Plan Type, select HMO or DHMO.

Attach the fee schedule you created earlier. Remember, if this is a non-HMO plan, select the appropriate fee schedule.

Click Save.

Go to the Deductibles, Maximums, and Coverage page. Click Edit Plan at the top right.

Set the Individual Annual Max to unlimited, unless the plan specifies otherwise. To enter unlimited benefits, enter 999,999,999 in the field for both total benefits and remaining for the patient.

In the coverage table, you'll see a default custom category (D0120 – D9999) set to 100% coverage. Leave this as is.

Individually add each code with its specific copay:

• Click + Coverage.

• 

• Choose the correct service category (like Restorative).

  

• Search for the procedure code or name.

  

• Enter the copay amount.

  

• Click the plus sign to add more codes.

   

When finished, click Save.

Veiw on the Treatment Plan

Open the patient's chart to begin treatment planning. Select the teeth and procedures needed, such as:

• Posterior composite on tooth 3 (1 surface).

• 2-surface composite on tooth 14.

• 3-surface composite on tooth 19.

   

Review the treatment plan. You'll see the specific copay assigned for each procedure.

For HMO plans, the patient's portion is shown, since there are no negotiated rates—only the set copays apply.

Congratulations! You’ve successfully added a copay-based or HMO plan into Archy. This setup ensures your billing and treatment planning workflow stays accurate when working with these insurance types.