Create and Send a Claim
Insurance Claims are created in the Account module after an appointment (and its attached procedures) has been Set Complete.
- In the Account module toolbar, select a New Claim option:
- To automatically create a claim for all procedures not billed to insurance, click New Claim without selecting any procedures. The Claim Type will be assigned based on the patient's insurance plan situation. If there is dual coverage, a Secondary Claim is automatically created with a status of 'Hold until Pri Received'.
- For more control, highlight specific procedures, then click New Claim, or click the dropdown to create a Primary, Secondary, Supplemental, or Other claim type.
- On the Edit Claim window verify the claim information and change if necessary.
- Send, print, or save the claim.
- Individual Claims: Preview, print or send an e-claim by clicking a button at the bottom of the Edit Claim window.
- Batch claims: It is common to leave the claim status as 'Waiting to Send' and click OK. Then, at the end of the day, print or send all 'Waiting to Send' claims at once. See Send or Print Batch Claims.
Note: When a patient has unearned income user will be prompted to Allocate the Unearned Income to completed procedures when creating the claim.
Once created, the claim will show in the Patient Account under the procedures. To edit, double click it.
- If sending a secondary claim using Claim Connect and NEA Fast Attach, any attachments (e.g. the EOB), need to be uploaded to NEA and documented in Open Dental before sending the claim. See E-claim Attachments.
- Claim text color is dependent on settings in Definitions, Account colors.
- Printing a claim automatically changes its status to 'sent'.
When you receive a claim payment, you must receive the claim and attach it to a payment. See Insurance Payments.
Questions and Answers
Q: In what order are deductibles and annual max applied?
A: Deductibles and annual max are applied in the order that claims are created, not by procedure date.