Understanding Open Dental: Claim & Account Warnings

claim and account warnings

Ever gotten a warning, message, or popup in Open Dental and weren’t quite sure what it meant? Well, in our multi-part series “Understanding Open Dental“, we’re going to review some of those messages so you know what they mean and how to handle them in the future.

In the previous posts of this series, we’ve already reviewed Security Warnings, Appointment Prompts & Warnings, and Popups & Other Patient Warnings. In this post, we’ll go over the various prompts and warnings you might see when dealing with claims or in the Account Module.

Claim Warnings

claim warning

When creating a claim, Open Dental will warn you as you exit the claim if there is any missing information. The warning will tell you exactly what is missing. If there is a set of missing/invalid data, it will all be listed on the same message.
Missing prosthesis information, provider NPI, subscriber birthdate, or other various information could cause a claim to be rejected. Note the warning before sending the claim to avoid having to fix and resend the claim later.

Claim Overpaid Procedure Warning

claim overpaid warning

When receiving a claim, you’ll get an Overpaid Procedure Warning if the total insurance payments, write-offs, adjustments, and patient payments exceed the procedure fee. If the Insurance Preference Payment exceeds procedure balance is set to Warn, you can click OK to proceed with entering the payment if this is a legitimate overpayment. Otherwise, click Cancel to return to the Enter Payment screen and correct the payment amount.

Claim Overpaid Procedure Warning – Blocked

If the Insurance Preference Payment exceeds procedure balance is set to Block instead, you’ll get the Overpaid Procedure Warning, but you cannot continue with the payment as it is currently entered. Click OK to return to the Enter Payment screen and correct the insurance payment amount.

If the Overpaid Warning is due to a patient payment, you may want to complete an income transfer to reallocate income from the procedure in order to enter the correct insurance payment if it is higher than originally estimated.

Auto Ortho Claim Payment

If your office does ortho and sends Ortho Auto Claims, you may get this message if you try to receive a payment on the wrong claim. Most offices will receive ortho payments on the original ortho claim, rather than the auto ortho claims, as these are $0 claims. If the Consolidate Ortho Insurance Payments is enabled in Ortho Setup, ortho payments must be entered on the original ortho claim. If payment is attempted on an Ortho Auto Claim, this message will appear. Click Yes to quickly open the original ortho banding claim to enter the payment. If No is clicked, the message will close, without opening the original claim, but they will still not be able to enter payment on the Ortho Auto Claim.

Overpaid Procedure Warning

When entering a payment split or adjustment that exceeds the remaining patient portion (i.e., what the patient still owes on a procedure), you may receive this message. If the Negative Adjustments Preference (coming in Version 22.4) is set to Warn, you will get this warning when trying to create a subtraction adjustment that exceeds what the patient owes on a procedure. You can click OK to proceed with creating the adjustment or click Cancel to return to the Edit Adjustment window if you want to fix the amount.

TECH TIP: The Remaining amount owed on the procedure is noted on the Edit Adjustment window.

This message will always appear when entering a payment split that overpays a procedure, but depending on your Preferences it may not show up for adjustments. You may receive a different message or no message at all.

Negative Adjustment Blocked

If the Negative Adjustments Preference (Version 22.4) is set to Block, you will receive this message instead of the message shown above. Unlike the message shown above, you won’t be able to proceed with the adjustment as entered. Click OK to return to the Edit Adjustment window and fix the adjustment amount, so the remaining amount is not negative. Once fixed, you can create the adjustment.

Insurance Overpayment Warning

When using the Income Transfer Manager, you may get this warning if you have overpaid insurance claims.

The Income Transfer Manager tool does not reallocate insurance overpayments to other claims or procedures. If you do have insurance overpayments, that will need to be dealt with manually. If insurance requires a refund or the overpayment should be allocated to a different claim, instructions can be found in our manual.

Now that you know a bit more about claim and account warnings, you won’t be caught off guard the next time one appears when using Open Dental! As always, if you need any help with anything, Support is here for you 🙂

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