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Claim Types

In the Account module toolbar, there are five options when creating a Claim: New Claim, Primary, Secondary, Medical, Other (See Claim Type Other below).  Open Dental assigns a claim type and other options based on the patient's insurance plan situation. The logic is as follows.

Insurance Plan Situation
(order listed in Family Module)

When you select:

New Claim

Primary

Secondary

Medical

Dental

Claim type: Primary
Med/Dent: Dental
Insurance Plan:
Dental Plan
Other Coverage: Blank

Claim type: Primary
Med/Dent:
Dental
Insurance Plan: Dental Plan
Other Coverage
: Blank

Message displays informing the user that the patient does not have secondary insurance.

Message displays informing the user that the patient does not have medical insurance.

Medical

Claim type: Medical
Med/Dent: Medical or Institutional
(default set in Account Module Preferences)
Insurance Plan:
Medical Plan
Other Coverage: Blank 

Message displays informing the user that the patient does not have any dental plans.

Message displays informing the user that the patient does not have secondary insurance.

Claim type: Medical
Med/Dent: Medical or Institutional (default set in Account Module Preferences)
Insurance Plan:
Medical Plan
Other Coverage: Blank

Dental Dental

Two claims are created (except in Canada only the primary is created).

Primary claim:
Claim Type: Primary
Med/Dent: Dental
Insurance Plan: Dental plan with lowest ordinal
Other Coverage: Dental plan with the second lowest ordinal

Secondary Claim:
Claim Type:
Secondary
Med/Dent: Dental
Insurance Plan: Dental plan with the second lowest ordinal
Other Coverage: Dental plan with lowest ordinal

Claim Type: Primary
Med/Dent: Dental
Insurance plan: Dental plan with the lowest ordinal
Other Coverage: Dental plan with the second lowest ordinal

Claim Type: Secondary
Med/Dent: Dental
Insurance plan: Dental plan with the second lowest ordinal
Other Coverage: Dental plan with the lowest ordinal.

Message displays informing the user that the patient does not have medical insurance.

Dental Medical

Same as Dental

Same as Dental

Message displays informing the user that the patient does not have secondary dental insurance.

Same as Medical

Medical Dental

Same as Dental

Same as Dental

Message displays informing the user that the patient does not have secondary dental insurance.

Same as Medical

Medical Medical Same as Medical Message displays informing the user that the patient does not have any dental plans. Message displays informing the user that the patient does not have secondary insurance. Same as Medical

​Dental Dental Medical

Same as Dental Dental

Same as Dental Dental

Same as Dental Dental

Same as Medical

​Dental Medical Dental

Same as Dental Dental

Same as Dental Dental

Same as Dental Dental

Same as Medical

​Medical Dental Dental

Same as Dental Dental​

Same as Dental Dental

Same as Dental Dental

Same as Medical​

Some settings can be manually changed. Users are also not blocked from manually changing the secondary plan on a claim, though this could result in the e-claim sending "secondary" claim information that is inconsistent with the situations listed in the table.

Claim Type Other
When a patient has three or more dental insurance plans, create an 'Other' type claim.

  1. In the main menu, click the New Claim dropdown, Other.

  

All plans the patient is currently subscribed to will list. To list all insurance plans for the family, including inactive or dropped plans, check 'Show plans for family which are not in use by the current patient'.

  1. Select the dental insurance plan.
  2. Select the patient's relationship to subscriber.
  3. Click OK.
  4. On the Edit Claim window verify the claim information and change if necessary.
  5. Send or print the claim.

 

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