Managing Insurance Claims
Insurance claims can be sent, printed, and managed on the Insurance Claims window.
In the Manage Module, click Send Claims.
This window is non-modal so you can open other windows while sending or validating e-claim.
The top half of the window lists claims that have a status of Waiting to Send.
Preview: View a claim before sending or printing.
Blank: Print a blank version of the default claim form.
Print: Print selected claims or, if no claims are selected, all paper claims.
Labels: Print individual labels for selected insurance carriers.
Send E-Claims: Validate and send all e-claims to the clearinghouse listed in the Clearinghouse column, or click the dropdown to validate and send to a specific clearinghouse.
Validate Claims: Validate selected e-claims for missing information prior to sending.
Get Reports: Manually retrieve reports from a clearinghouse. See Reports below.
Refresh: Update the Claims Waiting to Send grid.
Procs Not Billed: Open the Procedures Not Billed to Insurance Report and optionally create batch claims for unbilled procedures.
Close: Close the window.
The lower 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.
Date From / To: Only show claims and reports in a date range.
Type: Only show certain types of claims or reports. Single click an option, or to select multiple types, press Ctrl while clicking or Shift while clicking. If no options are selected, then all types will show.
Undo: If there was a problem with sending, highlight the claims and click Undo. The claims will move back to the Claims Waiting to Send grid.
Print List: Print the current contents of the History grid.
Outstanding Claims: Open the Outstanding Insurance Claims Report.
Claim History Grid
To view details about a sent claim, double click it.
If there is ever any need to troubleshoot a sent claim, the full text of the batch is saved here. Most of the text, as well as the fields below, are meaningful only to technical support.
Attachments Sent: Indicates if attachments were sent.
Note: Add a note that will display on the Insurance Claims window.
Acknowledgment: If the transaction has been acknowledged by the clearinghouse, then that information, including the full Message Text and Date/Time, will show at the right.
In order for a report to list in the History grid, it must first be downloaded to the Clearinghouse Report Path.
Reports can only be retrieved once per minute. If a user attempts to retrieve reports more than once in a minute, they will get an error. As reports are retrieved a progress bar will appear. Errors will be recorded in the Error Log. Users can pause or cancel the progress at any time.
Acknowledgment Reports: There are 4 types of acknowledgment report formats; 997, 999, 277, and 835. They are listed in the order in which they are received from the clearinghouse. 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. Older versions of Open Dental did not store the report in the database, but instead moved the file to an archive folder. Because of the new way that reports are handled, it is no longer important to always run e-claims from the same workstation. However, if you use Tesia, then TesiaLink should only be running on one computer at a time. Also, there is no need to manually archive reports. Reports that have been imported will show as rows in the lower history grid. Double click on the row to view or print. Use the Note field to make comments about each report that you will find useful.
Some clearinghouses use a web-based follow-up system rather than sending back text reports.