Insurance

FAQs Answered: Insurance Claims

insurance

Open Dental makes creating & sending insurance claims and receiving insurance payments quick and easy!


Here are a few FAQs on claims and claim payments in Open Dental

 

I clicked “New Claim” – the claim includes procedures from today, but also a few from a much older date of service – why is this happening?

When you click New Claim, Open Dental will create a claim for all completed procedures that have not been billed to insurance (no claim has been created yet). If there are procedures that were completed on an older date of service that were not billed to insurance, it will include those in the new claim. If you have completed procedures you don’t want to bill to insurance, open the procedure, and check the “do not bill ins” box – this will tell Open Dental that they don’t need a claim created. You can also select the procedures you want on the claim before you click New Claim – that way, only the procedures you’ve selected will be on the claim.

 

I accidentally deleted a claim I created – can I undo this action?

No, but don’t worry – just click New Claim to create the claim again.

 

I tried sending a claim but got an error about missing data. What’s this?

Open Dental validates the data on your electronic claim before it is sent. If you get an error about missing information (Cannot send claim until missing data is fixed), look at the text of the error – it will tell you what information needs to be fixed before the claim can be sent.

For more help on this error, watch the webinar.

 

I got an error that prosthesis date needs to be entered. I already indicated that in the procedure. Is there another place that needs this information?

Yes. In addition to indicating either initial or replacement in the procedure itself, you will need to indicate this in the General area in the lower left of the claim as well (see the screenshot below).

 

After sending the claim, we realized the wrong code was charted. What’s the best way to handle this?

Contact the carrier to have them delete the claim. Delete your claim in Open Dental, delete the incorrect code, re-chart the correct code and set it complete for the correct date of service (and attach it to the appointment). Re-create the claim for all procedures, and send to insurance.

 

We sent our claim but insurance paid on a different code – now what?

This happens quite often when insurance “re-maps” charted codes like a bitewing and pano, and pays them as an FMX. Read this post for the best way to handle this situation.

 

Insurance paid on some of the procedures but not all (and we’re still expecting payment on the rest). What’s the best way to handle this?

Select the procedures that were “skipped” by insurance (ctrl+click to select), then click “Split Claim” to split these off onto their own claim. That claim will remain outstanding and will show up in the Outstanding Claims report so you can see you’re still expecting payment.

Receive payment on the procedures insurance paid on, and finalize as usual.

 

Insurance sent an additional payment on a claim I already received payment on. How do I enter this extra payment?

Open the claim, and select the procedure the insurance sent the extra payment for, then click the Supplemental button. Enter the payment amount, and finalize as usual.

TECH TIP: Pay attention to the total paid by procedure. You may need to adjust the write-off amount so you don’t end up with an insurance overpayment. You may also need to edit your fee schedule if reimbursement amounts have changed.

 

Insurance sent us a check for interest. How do I handle this?

There are 3 options for handling interest payments from insurance, take a look in our user manual.

 

I have to repay the insurance company for an overpayment (or they’re pulling money back on a bulk check). What’s the best way to do this?

Follow the steps for an extra payment, but instead, enter the Supplemental payment as a negative number. If it’s a bulk check, finalize after entering all the other payments on that check. If it’s an individual payment, we recommend you enter the check number you’re using to repay insurance when you finalize the check.

 

Need help troubleshooting a claim issue or error message? Feel free to chat or call.

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