Insurance Limitations and Notes

Updating insurance limitations & notes in Archy ensures your patient records reflect the correct frequencies, age restrictions, and downgrades for dental procedures. Here’s how to efficiently tailor these settings for any plan.

Go to the Limitations page in your patient's insurance.

Click Edit in the upper-right corner.

Review the Default Limitations page. These are the most essential limits for your practice.

Set your frequency amounts. For example, enter 2 if exams are allowed twice per benefit year.

Choose the benefit period, such as Per Benefit Year.

For stricter frequency rules (like FMXs or Panos), use the slider box next to the dropdown for more options.

Adjust frequency, for example, 1 per visit every 60 months after the service date.

Add additional conditions, like a Maximum Age Limit for a procedure (e.g., Fluoride covered only up to age 16).

With limitations and frequencies, Archy supports flexible periods such as every number of months or years, per benefit year, lifetime limits, and settings by tooth, arch, surface, or quadrant.

To create more limitations or downgrades, go to the All Limitations page. Here you see your defaults and any existing downgrades.

Archy automatically adds common downgrades, like posterior composites downgraded to amalgams, for new plans. Remove these using the trash can icon if not needed.

Add new limitations or downgrades by clicking the + Limitation button.

Select the Procedure Code for your limitation—such as D0431.

Set the frequency and age rules (e.g., once per benefit year, minimum age 40).

To add a downgrade, use + Limitation, pick the code (like porcelain crown).

Then, under the Downgrade column, enter the code it downgrades to (like PFM).

Scroll to Plan Notes to add important plan-wide notes, such as policy limitations for occlusal guards. It is important to know that the Plan Notes are plan-specific and should not have any patient-specific information entered.

Click Save to confirm your changes.

You’ve now successfully updated insurance frequencies, age limits, downgrades, and plan notes in Archy. Keeping these settings accurate ensures every patient receives the right coverage according to your current policies.