Originally published on April 19, 2018. Updated January 18, 2024.
Open Dental makes creating & sending insurance claims and receiving insurance payments quick and easy! In this post, we’ll explore some FAQs on claims and claim payments in Open Dental.
Click on a topic to learn more:
- I clicked “New Claim” and the claim includes procedures with a much older date of service – why is this happening?
- I accidentally deleted a claim – can I undo it?
- I tried sending a claim but got an error about missing data – what is this?
- After sending the claim, we realized the wrong code was charted – what now?
- We sent our claim but insurance paid on a different code – what’s the best way to handle this?
- Insurance paid on some but not all procedures (and we’re still expecting payment on the rest).
- Insurance sent an additional payment on a claim I already received payment for – how do I enter this?
- Insurance sent us a check for interest – how do I handle this?
- How do I repay the insurance company for an overpayment (or they’re pulling money back on a bulk check).
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 Unsent procedures on the account. If there are procedures that were completed on an older date of service that were not billed to insurance, these will be included in the claim.
If there are completed procedures that do not need to be billed to insurance, double-click the procedure, and check the Do Not Bill to Ins box – this will make the procedures no longer Unsent on the account and they will also no longer appear on the Procedures Not Billed to Insurance Report.
If the procedures still need to be billed to insurance, select the procedures to include on a claim before clicking New Claim. Only selected procedures will be included. Repeat this process to create multiple claims for different procedures.
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.
After sending the claim, we realized the wrong code was charted. What’s the best way to handle this?
See our manual page: Incorrect Procedures On a Claim for scenarios, and our recommended steps.
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?
Receive payment for all procedures on the claim, including any procedures that insurance did not pay. Enter $0 payment for these procedures. If the procedures need to be re-submitted to insurance, select them and click Split Claim. A new claim will be created with the selected procedures. Update or add additional claim information as needed (e.g., attachments) and resend the claim. Skip this step if the claim does not need to be resubmitted to insurance.
On the claim with the procedures, enter a Pending Payment. Select the unpaid procedures and click Ins Underpaid. Enter the amount you’re expecting insurance to pay on the procedure(s). The Pending Payment is entered as a PndSup line on the claim. Once the payment is received, double-click this line and click To Supplemental to convert to a supplemental line item and receive the payment.
Insurance sent an additional payment on a claim I already received payment for. How do I enter this extra payment?
Open the claim, 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 three options for handling interest payments from insurance, take a look at the Insurance Interest page in our online 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.
Have other insurance questions? Contact our friendly and helpful Support Techs for all your questions or concerns.
Information in this post reflects features available in Open Dental Version 23.2. For the most up-to-date information, please visit our manual.