Outstanding Insurance Claims Report
The Outstanding Insurance Claims report is useful for tracking claims that have been sent, but not received. From here you can also update tracking status for many claims at once or delegate staff to follow-up on claims.
Note: To control user access to this report, see Report Setup - Security Permissions.
- In the Main Menu, click Reports, Standard.
- In the Monthly section, click Outstanding Insurance Claims.
Claims that meet the filter criteria will list. Click a column title to sort results in ascending or descending order. To view a claim, double click it.
Filter Options: If you change filter criteria, click Refresh to update list of results. Customize the columns that show using Display Fields. See Customize the Report section below.
- Days Old (min/max): Filter by claim age. The default is 30 days. The age is based on the Date Sent as entered on the Edit Claim window, not the Date of Service. Thus, claims recently sent can be excluded from the report. Leave both fields blank to show all claims.
- Include Preauths: Include Preauthorizations.
- Ignore Custom Tracking: Do not consider or show claim tracking status in report results (Edit Claim window, Status tab). If ignored, the Track Status and Date Status columns will not show, 'days suppressed' values as a result of the status will be ignored, and the report will print in portrait mode. If custom tracking status does show in the report (this box unchecked), the report will print in landscape mode.
- Use Date Orig Sent: Determines the column header and data for Date Sent/Orig Sent. When unchecked, the Date Sent column shows the date the last claim was sent. When checked, the column header changes to Orig Sent and the date the claim was originally sent shows.
- Treat Provs: Filter the report by treating provider. Click the dropdown, then highlight the providers to include. Press Ctrl while clicking to select multiple providers.
- Clinics: Filter by Clinic. Click the dropdown, then highlight the clinics to include. Press Ctrl while clicking to select multiple clinics.
- For User: Only list outstanding claims assigned to a specific user for follow-up. Use the dropdown, click [...] to select from a pick list (Select All = All Users. Select None = Unassigned.), or click Mine to only view outstanding claims assigned to the logged-on user.
- Last Claim Custom Tracking Status: Filter by last recorded claim tracking status. Click the dropdown to select an option. Custom track statuses are set up in Definitions, and attached to claims in the Edit Claim window, Status Tab.
- Carrier: Filter by insurance carrier. Enter the carrier name.
- Last Error Definition: Filter by Claim Error. Error codes are set up in Definitions, and attached to claims in the Edit Claim window, Status Tab.
Columns (these show by default):
- Carrier Name: The insurance carrier.
- Phone: The insurance carrier's phone number.
- Type: The type of insurance (primary, secondary, etc).
- User: The user assigned to follow-up on the claim.
- Patient Name: To show patient numbers with names, in Report Setup - Misc Settings, select the "Show PatNum: Aging, OutstandingIns, ProcsNotBilled:" option.
- Clinic: The clinic on the claim.
- Date Sent / Orig Sent: If label is Date Sent, the date the claim was last sent shows. If Orig Sent, the date the claim was originally sent shows.
- Track Stat: The last claim tracking status entered. This column won't show if ' Ignore Custom Tracking' is checked.
- Date Stat: The date the track status was entered. This column won't show if ' Ignore Custom Tracking' is checked.
- Error: The Claim Error code, if one exists. This column won't show if 'Ignore Custom Tracking' is checked.
- Amount: The total fee billed to each carrier. This is not the amount that will be paid, so do not use it to determine outstanding insurance payment amounts.
Additional columns: See Customize the Report section below to add these columns.
- GroupNum: Group number for the subscriber.
- GroupName: Group name for the subscriber.
- SubName: Subscriber name.
- SubDOB: Subscriber date of birth.
- SubID: Subscriber ID.
- PatDOB: The date of birth of the patient on the outstanding claim.
Right click options: Right click on a claim row to select one of the following options:
- Go to Account: Jump to the patient's Account module without closing the report window.
- Assign to Me: Assign the claim to the logged on user.
- Assign to User: Assign the claim to any user.
Assign Claims to Users
This tool is useful for delegating responsibility for outstanding claims to specific staff members.
- Highlight the claim(s) to assign.
- To assign to the logged on user: Right click, then select 'Assign to Me'
To assign to any user: Right click, select Assign to User, then select the user. Or, click Assign User, select the user from the Pick User window, then click OK.
To remove a claim assignment, right click and select another user or open the 'Assign User' window and click 'Select None'.
Update Claim Tracking Status
Use this tool to change the Track Status and/or Error Code of all claims currently in the grid. The tool is only enabled for users who have the Update Custom Tracking Permission. See Edit Claim window, Status tab for tracking status and error code information.
- Change report filter criteria as needed.
- Click Update Custom Tracking.
- Click the dropdown to select a status.
- Add a note if desired.
- Click Update. The Track Status, Error Code and Date Status for all claims will update.
Customize the Report
Use Display Fields to customize which columns show when the report is run.
- In the main menu, click Setup, Display Fields.
- Double click Outstanding Ins Report.
- Add and remove columns that show using the left and right arrows.
Printing the Report
To print the report directly to the printer, click Print.
Export the Report
To export the report as a .txt or .xls file:
- Click Export.
- Select the location to save the file, and the file type. The default is the OpenDentalExports folder as set in Data Paths.
- Click Save.