Printed Claim Forms are set up from the Claim Forms window.

In the Main Menu, click Setup, Family/Insurance, Claim Forms.

This page only contains information about Claim Forms that are printed. The information in a printed Claim Form does not affect what is sent in e-claims.

Also see:

• ADA Claim Forms: How fields in a printed ADA 2012, 2018, 2019, and 2024 Claim Form are populated.
• HCFA 1500 Claim Form: How fields in a printed 1500 Claim Form are populated.

Claim Forms

Open Dental includes multiple internal forms to choose from. Optionally, forms can be customized or new forms added.

Internal Claim Forms: The original Claim Form templates that come with Open Dental. Double-click a form name to open a read-only copy.

Custom Claim Forms: Claim Forms that can be customized, duplicated, imported, exported, or deleted. Double-click a form name to open Claim Form Edit.

Copy: Click to copy an Internal form to the Custom grid.

Set Default: The default Claim Form determines the default Claim Form when a new Insurance Plan is created. Highlight a custom form, then click to set it as the default. An X appears in the Default column.

Reassign Claim Forms

Old Claim Forms associated with insurance plans can be reassigned to an updated form.

1. Import or create the new Claim Form.
2. In the Custom Claim Forms grid, highlight the old form.
3. Click the Reassign dropdown and select the new form.
   
4. Click Reassign. A message indicates how many insurance plans were affected by the reassignment.

Custom Claim Form Options

These options apply to forms in the Custom Claim Forms grid.

Add: Click to create a new blank Claim Form. Opens Claim Form Edit.

Delete: Highlight a Claim Form, then click to delete. Only do this when the Claim Form is not in use for any insurance plans.

Duplicate: Highlight a Claim Form, then click to create a duplicate.

Export: Highlight a claim form, then click to export in XML format. When the Windows File Explorer opens, choose where to save the XML.

Import: Import a Claim Form from an XML file.

• Requires an XML file exported from Open Dental.
• Most Claim Forms require a background image (GIF or JPEG) in addition to the XML.
• To Import:
  1. Save the XML file and the image file to the A to Z Folder (i.e., OpenDentImages folder).
  2. Click Import and select the XML file.
  3. The new form appears last in the Custom Claim Forms list. Once imported, the XML file is no longer needed by Open Dental and can be deleted from the A to Z folder.
  4. See Claim Form Edit to add a background image.