Send Claims

View claims waiting to be sent, a history of sent claims, validate and send claims, and more.

In the Manage Module, click Send Claims.

Insurance claims can be sent, printed, and managed on the Insurance Claims window.

This window is non-modal so users can open other windows while sending or validating claims.

Toolbar

Claims Waiting to Send

The Claims Waiting to Send grid lists claims that have a status of Waiting to Send. Click a column header to sort.

Filter options: Set the filter criteria and click Refresh in the top toolbar to update the claims listed in the grid.

Columns:

Claim History

The History grid lists all claims sent or printed from this window and received reports (e.g., ERAs, acknowledgment reports). Double-click an item to view more information. Right-click an item to Go To Account. The list of claims and reports can be filtered by date or type.

Filter Options: Set the filter criteria and click Refresh in the Claim History grid toolbar to update the claims listed in the grid.

Columns:

Note: In order for a report to list, it must already exist in the clearinghouses default Report Path. Users can set up automatic download, manually download (click Get Reports), or manually save the report file in the correct folder. Not all insurance carriers offer ERAs, reports, or the ability to automatically download.

Etrans Edit/Claim Details

To view details about a sent claim, double-click it to open the Etrans Edit window.

Message Text Sent: Contains any data sent for an electronic claim (i.e., X12).

DateTime Trans: Date and time claim was printed or sent electronically.

AckCode: Acknowledgement code received from clearinghouse. Displayed if a 997 or 999 acknowledgement is received. See Reports section below.

Note: Text that displayed on the Insurance Claims window, History grid.

Reports

Reports must be downloaded to Clearinghouse Report Path to be listed in the History grid.

Reports can only be retrieved once per minute. As reports are retrieved, a progress bar appears. Errors are recorded in the Error Log. Users can pause or cancel progress at any time.

Acknowledgment Reports: Clearinghouses are not obligated to provide these acknowledgment reports and may choose to return some or all reports for some batches and not others.

Text Reports: Reports usually come back from the clearinghouse as files placed in the report path specified in the Edit Clearinghouse window. They are then automatically imported by Open Dental and stored in the database. The original text file is deleted. Some clearinghouses use a web-based follow-up system rather than sending back text reports.