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Receive a Claim

Receiving claims is part of the process when entering an Insurance Payment.  'Receiving' means entering payment amounts, thus changing the procedures and claim status to 'Received'.  Once received, finalize the payment by attaching the received claims (see Finalize Insurance Payments).

For each claim on an EOB, follow the steps below to receive it.

  1. In the Account module, double click on the Claim.
  2. To enter paid amounts, you have two options.
    • By Procedure:  Itemize the payment by procedure.  We strongly recommend this method.  If the plan is a PPO, this is required so writeoffs show properly in reports (Total will be disabled). If you choose this option the list of procedures will show (see below).  Proceed to step 3.
    • Total:  Enter a total payment amount. This will attach the amount to the claim, but not a specific procedure.  The Claim Procedure window will open.  Enter the Insurance Paid amount and click OK.  A line item for Total Payment will show in the Procedures grid.  Proceed to Finalize Insurance Payments.

The Ins Pay amounts will be automatically filled based on insurance estimate calculations.  The Status will be 'Recd' (received).  The Totals at the bottom for deductible and insurance paid should exactly match the EOB.

  1. If needed, edit insurance payment information. 
    • Double click on Date, Prov, Code, Th, Description, Fee Billed or Status to open the Claim Procedure window and edit information.
    • Deduct: Automatically calculated based on benefit information. Click in the cell to manually edit. To reassign a deductible to a different procedure, highlight the procedure, then click Deductible.
    • Allowed: Entered amounts will be saved to the Allowed (out of network) Fee Schedule for this insurance plan and used to calculate better estimates for patients with the same carrier.  Out of network fee schedules can be automatically generated by the Blue Book program.
    • Ins Pay: Automatically calculated based on benefit estimates. Click in the cell to edit.
    • Writeoff: Automatically calculated. Click in the cell to edit or click Write Off in the lower left to create a writeoff for all unpaid amounts by procedure (Fee Billed - Ins Pay).
    • Pay Tracking: Click in cell to select from a list of options (defined in Definitions, Claim Payment Tracking). Useful to track why payments are rejected.
    • Remarks: Click in the cell to enter remarks for any procedure that has a remark in the EOB. 

  2. Click OK to save the procedure payment amounts.  The claim status will change to 'Received'.
  3. Continue steps 1 - 4 to receive other claims on the EOB. 
  4. After you receive the last claim on the EOB, Finalize the Payment.

Hint:  If you enter all the EOB information, including remarks, you can file the EOB and never have to refer to it again. All the information will be in Open Dental and accessible from any computer.  If a patient calls to complain insurance did not pay as expected, you can quickly determine exactly which procedures were not paid and why.

If primary insurance is not paid as estimated, secondary insurance estimates do not update.

Claims with No Payment
If no payment is made on a claim, you must still receive it. Simply enter 0 as the insurance payment amount (As Total or By Procedure). This will mark it as 'Received' so it is no longer considered an 'outstanding' claim.

To scan the EOB associated with the zero payment, finalize the payment as normal (enter 0 as the amount) then scan. See Scan EOB.

In the Patient Account, claims received with no payment show as follows:

Questions & Answers
Q: What if I cannot enter (receive) all of the claims that make up my bulk check/payment and I need to leave for the day?
A: Do not finalize the payment until you finish receiving all the claims. This way all claim payments will have the same payment date.

 

Open Dental Software 1-503-363-5432