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Fee schedules and date maps

Ordo can only tell you whether an insurer underpaid if it knows what they agreed to pay. That is what fee schedules are for.

  • A fee schedule is a list of CDT codes and fees — “Cigna PPO 2026: D1110 $104, D2750 $865, …”.
  • A date map says when a fee schedule applies — “Cigna PPO 2026 applies from 2026-01-01 onward.”

Payment Analysis, Payment Analytics, and Fee Analysis all look up fees the same way: insurer + CDT code + date of service.

You manage both in Clinic settings → Insurance. Changing them needs the Manage fee schedules permission (Owners and Admins by default).

Where they live

Clinic settings → Insurance has two sub-tabs:

Sub-tab What is in it
Insurers One row per insurance company. Open an insurer to see its Formats (which EOB layouts it sends) and its Fee schedule (contracted fees and date maps).
Office Fee / UCR (N) Your office’s own fees (UCR / usual and customary). N is how many Office / UCR schedules you have.

Office / UCR fees are shown next to contracted fees for comparison. They are never used to calculate an underpayment.

Add a fee schedule

Open an insurer’s Fee schedule tab (or Office Fee / UCR), then click Add fee schedule.

  1. Name — something you will recognize next year, such as Cigna PPO 2026.
  2. Insurance provider (optional) — already filled in when you start from an insurer. On the Office tab it says None — office / UCR.
  3. Get fees from — pick one:
    • Upload file — a .txt, .tsv, or .csv with columns CDT, fee, abbreviation, description (tab- or comma-separated). Up to 5,000 codes. Download sample gives you a template.
    • Open Dental — choose one of your Open Dental fee schedules from the list (Refresh list if it is empty), then click Fetch fees. This uses the Open Dental connection for the location you are in.
  4. Check the code count (for example “412 codes ready to save”), then Save fee schedule.

Saving a schedule does not make it apply to any dates yet. You still need a date map.

Add a date map

At the top of the insurer’s Fee schedule tab (or the Office Fee / UCR tab), the Date mapping card lists which schedule applies for each date range.

  1. Click Add date map.
  2. In Add date mapping, choose the Fee schedule.
  3. Effective from — the first date of service it covers.
  4. Effective to (optional) — leave empty for “until further notice.”
  5. Label (optional) — for example Cigna PPO CY2026.
  6. Save mapping.

To stop using a mapping, click Remove on its row. The fee schedule itself stays.

Overlaps are blocked. For one insurer, two date ranges cannot cover the same day. If you try, you see Date range overlaps an existing mapping (…). Close the old range first — give it an Effective to date — then add the new one.

All Office / UCR maps share one timeline in the same way.

How Ordo picks the fee for a date of service

For each procedure, Ordo:

  1. Finds the insurer’s date maps that cover the date of service.
  2. Uses the one with the latest Effective from date.
  3. If the insurer has no covering map, tries its parent carrier (for example a regional plan that shares the national schedule). Fee Analysis marks this with a parent badge.
  4. Looks up the CDT code in that schedule.

If nothing is found, the line shows NA with Missing clinic fee / Fee schedule review, and no underpayment is claimed.

Example: Bright Smile’s 2026 Cigna contract

Cigna sends Bright Smile a new fee schedule starting January 1, 2026.

  1. Sarah opens Clinic settings → Insurance → Insurers → Cigna → Fee schedule.
  2. Add fee schedule: Name Cigna PPO 2026, Upload file, picks the spreadsheet Cigna sent (saved as CSV). 388 codes. Save fee schedule.
  3. In Date mapping, the existing row says Cigna PPO 2025 · 2025-01-01 → open. She removes it and re-adds it as 2025-01-01 → 2025-12-31.
  4. Add date map: Cigna PPO 2026, Effective from 2026-01-01, Effective to empty. Save mapping.
  5. She checks with Fee Analysis on 2025-12-31 and 2026-01-02 that the fees change.

Claims from 2025 still use the 2025 fees. Claims from 2026 use the new ones.

Office / UCR — one schedule for all dates

If your office fees rarely change, you do not need a map per year. Bright Smile keeps one Office / UCR map: Office Fees, 2022-01-01 → open. Every date of service since 2022 uses it.

Common problems

What you see Likely cause Fix
Many lines show NA / Missing clinic fee The insurer has no date map covering those dates, or the mapped schedule is missing those codes. Add or extend the date map; add the missing codes to the schedule.
— in almost every row in Fee Analysis The mapped schedule is empty or has only a handful of codes (for example a schedule fetched from a nearly empty Open Dental book). Replace it with a complete schedule and re-map.
New fees did not take effect The old map is still open-ended, or the new map starts on the wrong date. Give the old map an Effective to date; check Effective from on the new one.
Date range overlaps an existing mapping Two ranges for the same insurer cover the same day. Close the older range first.
The schedule you want is not in the Add date mapping list The list only shows schedules tagged to this insurer, or already mapped to it. Add the schedule from this insurer’s Fee schedule tab (or pick this insurer as its provider).

After fixing a schedule, run the analysis again — saved results keep the fees they were calculated with.