Originally published October 22, 2020. Updated December 21,2023.
As part of the patient treatment process, it may be necessary to submit medical insurance claims. Fortunately, Open Dental is equipped to handle these situations, but there are a few steps that need to be taken to ensure the process runs smoothly. In this post, we will cover the necessary system setup, including enabling medical insurance, cross-coding CPT codes to ADA codes, and downloading ICD-10 codes. Additionally, we will go over the insurance plan setup and how to chart medical procedures and submit medical claims.
One-Time Setup
Enable Medical Insurance and Public health
Go to Setup, Advanced Setup, Show Features. Then check Medical Insurance and Public Health (this is only necessary if you’ll need to change the Place of Service, e.g., for telehealth or if treating inpatient, or if you happen to use other Public Health features).
Create a Procedure Code Category for Medical Codes
In Setup, Definitions, Proc Code Categories. Click Add to create a new category for any CPT codes you’ll be adding, so they’re easily sorted away from your dental codes.
Cross-Code Medical Codes to ADA Codes
Next, you’ll need to create the medical codes you’ll be using in Open Dental so they can be cross-coded with ADA codes.
Go to Lists, Procedure Codes. Then click +New.
Enter the following:
- Procedure Code: Enter the Medical Code
- Description: Enter the Medical Code Description
- Abbreviation: Enter an abbreviation for the Medical Code
- Category: Select the new procedure code category we created earlier (e.g., Medical)
Then click Add or, if adding multiple Medical Codes, quickly move to the next code by clicking Add, then another.
Now, cross-code the CPT code with the ADA code. Back in the Procedure Codes list, find the corresponding dental code and double-click to open the Edit Procedure Code window.
Enter the CPT code in the Medical Code box, and that’s it! Do this for each dental procedure with a corresponding Medical Code.
Download the ICD-10 Codes
Medical claims require diagnoses, so you’ll want to download the latest ICD-10 codes. Go to Setup, Chart, EHR.
Click Code System Importer.
- Click Check for Updates.
- Highlight ICD10CM.
- Click Download Updates.
The latest ICD 10 Codes will be imported into your database.
Turn on the Preference to Use ICD-10 Codes by Default and Set a Default Diagnosis Code
Go to Setup, Preferences. Check the box to ‘Use ICD-10 Diagnosis Codes’.
This is optional, but you can also set a ‘Default ICD-10 code for new procedures and when set complete’. This is also in Preferences. Just type in an ICD-10 code (e.g., K02) or click […] to search for a code. The selected code will automatically be assigned as a diagnosis to all procedures going forward.
Set up a Medical Clearinghouse
This step is only necessary if you’ll be sending medical claims electronically. If instead you’re printing and mailing claims, you can skip this step. Your regular dental clearinghouse generally will not be the same one you use to send medical claims, so you’ll want to get signed up with a medical clearinghouse (like ChangeHealthcare Medical or EDS Medical).
Once you’ve contracted with a clearinghouse, see our manual for setup instructions for your specific clearinghouse.
Insurance Plan Setup
Now that you’ve completed the initial setup, you’re ready to set up medical insurance for your patients. To set up an insurance plan as Medical, follow the steps below.
Enter the insurance plan as usual, but ensure Medical Insurance is checked.
In the Other Ins Info tab, change the claim form to a medical claim form (typically “1500_02_12”, this is the updated HCFA 1500 form). This is especially important if you’ll be printing and mailing medical claims, but keep in mind, it does not affect Medical Claims sent electronically.
Note: HCFA 1500 Claims must use preprinted forms due to their red background. When printing from Open Dental, claim data will print to the proper areas of the pre-printed form, but by default, a background is not printed.
Chart the Procedures
Chart the dental procedures for the patient. Double-click into the procedure, and click the Medical tab.
TECH TIP: Only the dental procedures need to be charted if they’re cross-coded to medical codes. Charting dental procedures and medical procedures separately may cause your patient to be double-billed.
The Medical Code will automatically pull in the code we cross-coded earlier.
If you set a default ICD-10 diagnosis, there will already be one diagnosis code attached to the procedure. If you want to remove the default diagnosis, click None to clear it. Click […] to enter search and enter an ICD 10 code. Up to four Diagnosis Codes can be entered.
At least one procedure on a medical claim must be marked as Princ Diag. If this procedure includes your Principal Diagnosis for the claim, check the box.
If you need to edit the Place of Service, click the Misc tab.
Send the Claim
Once the procedure is set complete, create the claim.
Highlight the procedure(s) to be sent, then use the New Claim dropdown menu to select Medical.
When the claim is created as Medical, any procedures cross-coded with Medical Codes will be billed with these procedure codes, rather than dental codes.
Enter additional information you may need for a medical claim in the Medical tab of the claim.
Once you’ve finished entering any additional claim information, the claim is ready to be printed and mailed or sent electronically if you’ve set up a medical clearinghouse. From here, medical claims will be managed just like your dental claims.
If you have any questions about medical claims or need help troubleshooting something, call or chat with our helpful Support Team.
Information in this post reflects features available in Open Dental Version 23.1. For the most up-to-date information, please visit our manual.