Tips for Getting Insurance Claims Paid Promptly

If your Outstanding Insurance Claims Report has a balance that makes your hair stand on end, this post is for you! We’ll be going through some steps you can take in Open Dental (and in your Clearinghouse Portal) to prevent issues that may be causing insurance payment delays.

Enter complete patient and insurance information in Open Dental

Your Patient Registration form is the ideal place to collect the patient’s name, address, and date of birth. Their subscriber information (Carrier name, address, group name) should be collected in the Insurance section. If you are using Web Forms, you’ve likely already collected this information before their visit, and importing that information into the patient’s account in Open Dental saves time and prevents data entry errors.

Claims can be rejected if your insurance Carrier address is missing or the wrong payer ID is attached, so make sure to check this as you set up the patient’s Insurance Plan. Use the Pick from List button when you’re adding insurance to prevent duplicate plans from being added.

Verify Insurance before the patient comes in

See a list of patients whose insurance eligibility and benefits need to be verified:

  1. Use the Insurance Verification List to quickly identify patients with insurance benefits and patient eligibility that need to be verified. You can also assign ownership of verifications, then track, change, and manage verification status.
    See our Managing the Insurance Verification List Webinar.
  2. Add an insurance verification indicator to your Appointment View. When VerifyIns[V] is added to your appointment view, a V icon will display if insurance has not been verified. See Insurance Verification Setup for the settings that determine when this will display.

Request and/or import benefits information electronically:

If you have set up Electronic Eligibility and Benefits with a clearinghouse and a Subscriber ID is entered, click Request to request benefit information or History to view a history of requests. (If using Trojan, click Import Benefits).

The following third parties are known to offer eligibility services:

TECH TIP: Human intervention is important when importing benefit information, so only the relevant plan info is imported (as imports will often include information on other plans).

Record verification status:

Once you’ve verified insurance, use the Benefits Last Verified area to record the date insurance benefits were last marked verified (manually or using the Insurance Verification List). Click Now to insert today’s date.

Add the correct attachments when sending claims

Some claims need more detail. Here are some attachments that are generally needed with major procedures.

  • Endo: x-rays and narrative
  • Scaling and root planing (SRP): perio chart, full mouth series x-rays (FMX)
  • Crowns: x-rays, intraoral photos, narrative, initial or replacement*
  • Bridges/implants: x-rays (include full arch), narrative, initial or replacement*, missing teeth
  • Extractions: x-rays and narrative
  • Guards: upper/lower and narrative
  • Ortho: narrative

* In Open Dental, indicate initial/replacement on both the procedure and the claim.

Check for rejected claims

Your clearinghouse will provide a portal for you to use to check for rejected claims, and you should be doing that frequently, as this information is not displayed in Open Dental. Your clearinghouse portal will show any claims that were rejected and the reason, so you can resolve the issue quickly and resubmit the claim right away to prevent further payment delays. Frequent attention to this item will keep any fixes manageable.

Run Insurance Reports

Procedures Not Billed to Insurance Report

This report shows patients with procedures completed on the date/in the date range you select, where no claim has been created. Go to each patient’s account to take the appropriate next step.

  • No claim has been created for the completed procedures
    Create the claim and send it.
  • There is no need to create a claim for the completed procedures
    If there is no need to bill insurance in this instance, double-click to open the procedure and check the “Do Not Bill to Ins” check box. Once checked, procedures will show  as “No Bill Ins” and will no longer show in the report.
    * For procedures that are rarely or never billed to insurance (regardless of plan), go to Lists-Procedure Codes, double-click to open the Edit Procedure Code window, and check “Do not usually bill to Ins.”
  • Claim was created for the procedure(s), but procedure showing (Unsent)
    Double-click to open the Procedure Info window, and check in the Insurance Estimates and Payments grid to see if any duplicate estimates exist. If they do, you can open and delete the estimate.
Claims Not Sent Report

This report shows claims created on the date/in the date range you select that have not yet been sent to insurance. It also shows secondary claims that are in “Hold” status until the primary insurance claim payment is received.

Manage all unsent claims through the Manage Module. Click the Send Claims button – the upper grid shows all items waiting to be sent. (NOTE: Preauthorizations waiting to send are also displayed – you can tell them apart because preauths will have 01/01/0001 as the Date of Service.) Right-click on a claim to go to the patient account to investigate further or take the necessary action to correct any missing information before sending. You can also validate and send claims from the Manage Module, using the Send Claims button.

Unfinalized Insurance Payments Report

If you’re on Version 17.4 or newer, this report is now conveniently located in your Reports menu. This report should be run every day, to ensure that all insurance payments you’ve posted have been finalized. Once finalized, they will show up on your Payments Report.

TECH TIP:  Making sure payments have been finalized is critical because once you’ve posted the payment to the claim, the claim will be marked as received, and will no longer show up in your Outstanding Claims report (you’ll lose visibility to the receivable). The insurance payment will also NOT show up in your Payments Report or Production & Income Reports until finalized. The only way to see unfinalized payments is to notice the note on the payment in the patient’s account, or by running this report.

You work hard to provide excellent care to your patients, and you deserve to receive insurance payments in a timely manner. Taking these steps will help prevent issues that could cause delays in receiving insurance payments. Need help with anything here, or in other areas of Open Dental? Our Support Technicians are here for you, so reach out anytime!

Categories: Insurance, Tips & Tricks

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