Insurance

Handling Medical Insurance in Open Dental

Medical Insurance

As part of your patient treatment, you may also submit Medical Insurance claims from time to time. Open Dental is set up to handle these scenarios, but there is a little setup needed to make sure things run smoothly. This post will discuss the system setup including enabling medical insurance, cross-coding CPT codes to ADA codes, and downloading ICD-10 codes. We’ll also cover patient setup, and the process to chart medical procedures and send medical claims.

One-Time Setup

First, Enable Medical Insurance and Public health

Go to Setup > Advanced Setup > Show Features. Then check Medical Insurance and Public Health.

Medical Insurance

Next, Cross-Code CPT Codes to ADA Codes

Next, you’ll need to create the commonly-used medical codes in Open Dental so they can be cross coded.

Go to Lists > Procedure Codes. Then click +New.

Enter the following:

  • Procedure Code: Enter the CPT Code
  • Description: Enter the CPT Code Description
  • Abbreviation: Enter an abbreviation for the CPT Code
  • Category: Change this to Medical

Then click Add. If adding multiple CPT Codes, quickly move to the next code by clicking Add, then another.

Now, cross-code them. Find the corresponding dental code and double-click.

Medical Insurance

Enter the CPT Code in the Medical Code box. And that’s it! Do this for each dental procedure that needs a CPT Code.

Then, Download the ICD-10 Codes

To download the latest ICD-10 codes. Go to Setup, Chart, EHR.

Medical Insurance

Click Code System Importer.

  1. Click Check for Updates.
  2. Highlight ICD10CM.
  3. Click Download Updates.

The latest ICD 10 Codes will import.

Finally, turn on the preference to use ICD-10 codes by default.

Go to Setup > Chart > Chart Preferences. Check the box to ‘Use ICD-10 Diagnosis Codes’.

You’re now done with system setup. Time for the next step.

Patient setup

If a patient needs a medical claim sent, start by adding their Medical Insurance.

Medical Insurance

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 the HCFA 1500).

Note: The HCFA 1500 Claim Form is not included in Open Dental. You must purchase blank claim forms separately, then Open Dental is set up to print in the proper boxes.

Chart the Procedures

Chart the dental procedures for the patient. Double-click into the procedure, and click the Medical tab.

Medical Insurance

The Medical Code will automatically pull in the code we cross-coded earlier.

At least one procedure on a medical claim must be marked as Princ Diag.

Click […] to enter search and enter an ICD 10 code. Up to 4 Diagnosis codes can be entered.

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 your medical procedure, then use the New Claim dropdown menu to select Medical.

Medical claims can be printed and sent or, if a medical-capable clearinghouse is enabled, sent electronically.

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If you have any questions about medical claims or need help troubleshooting something, we’re always here for you! For a quick answer, use chat, and if you need us to remote-connect to help, please give us a call.

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