Find below instructions on how to correct a Claim with errors on the included procedure codes, or attached providers.

Correcting claims may involve editing historical data. Any changes to historical procedures, claims, or payments may affect financial history or reports. Contact Open Dental Support if you are unsure which steps are best to correct your claim.

Incorrect Procedure Codes on Claim

If you create a claim that contains incorrect procedure codes and have not sent it:

1. Delete the Claim.
2. Edit or delete the procedures.
3. Recreate claim, then send it.

If you create a claim that contains incorrect procedure codes, send it, and then realize the error or the insurance company denies the claim:

1. First make a Commlog entry in the account explaining why payment denied.
2. Open the claim and change its status to Waiting to Send.
3. Delete the claim.
4. Edit or delete the procedures.
5. Recreate claim, then send it again.

Alternatively, to retain the historical claim do not follow the above steps and instead take the following steps:

1. Receive the original claim and mark the incorrect procedure as Received with $0 payment and $0 write-off.
• Optional: Scan in the EOB showing non-payment or add a note indicating a reason for non-payment.
2. Add a subtraction Adjustment for the amount of the incorrect procedure. Associate it to the incorrect procedure.
3. Chart and complete the correct procedure and backdate to the original date of service.
4. Create a new claim for the corrected procedure.
5. Send the new claim.

If an incorrect procedure is submitted to insurance, insurance pays and check is created, then insurance company requests refund:

1. Open the claim.
2. Select the procedure(s), then click Supplemental in the Enter Payment area.
3. Enter a negative insurance payment (refund), then click OK.
4. If a check needs to be written from the practice to the insurance company, write the check, but leave the entry out of the deposit if using a Deposit Slip.
5. If the insurance company is subtracting payment from a check for other patients:
   1. Add a subtraction adjustment to the patient's account. The amount should equal the fee charged minus the write-off (e.g., patient portion).
   2. When that bulk check that includes the negative payment is created, the amount is correct. Deposit as normal.
   3. Do not change the write-off (if any) on incorrect procedure(s).
   4. Leave the date as today's date to preserve the record.
   5. The incorrect procedure should stay on record. Select the procedures, add a note that it was not done, and check the HideGraphics box.

   The reason the incorrect procedure needs to stay on record is that paperwork has been submitted to the insurance company and money has exchanged hands. Just removing it makes it harder to explain in the account and makes your reports incorrect. If you must leave the incorrect procedure because of a claim, just add and predate the correct procedure code after you have followed the steps above. Send the claim again as needed.

If you just need to change a procedure code and there is no claim attached, click Change on the Procedure Info window.

If an incorrect procedure is submitted to insurance, insurance pays and requests a corrected claim:

1. Commlog or notate on the claim that a corrected claim is necessary.
2. For the incorrect procedures on the original claim, create an adjustment to adjust off the procedure amount. This zeroes out the procedure fee.
3. Chart the correct procedures for the original date of service.
4. Create a new claim with the corrected procedures and service dates and send to insurance.
5. We recommend contacting insurance to discuss any potential refunds.

If an incorrect procedure is submitted to insurance, insurance pays, insurance then requests a corrected claim, and requests a refund for the difference.

1. Open the original claim.
2. Select the procedure to be refunded and click Supplemental.
3. Enter a negative insurance payment (refund) for the original insurance payment amount, then click OK.
4. For the incorrect procedure, create a subtraction adjustment to zero out the procedure fee.
5. Chart the correct procedure for the original date of service.
6. Create a new claim with the correct procedure and service date.
7. Click By Procedure to receive the original insurance payment from the original claim.
8. Enter a negative insurance payment (refund) for the amount being refunded to the insurance.

If an incorrect procedure was submitted to insurance, insurance paid for the other procedures, but they want the paid procedures and corrected procedure back on one claim.

1. Delete the check insurance had paid for the other procedures.
2. Delete the claim.
3. Add a subtraction adjustment for amount of the incorrect procedure. Associate it with the incorrect procedure.
4. Chart and complete the correct procedure.
5. Create the claim with the already paid procedures and corrected procedure.
6. Send the claim.
7. Enter the check for the paid procedures. Leave the corrected procedure as a zero payment.
8. Change the claim status to Sent. This way it can be tracked on the Outstanding Claims Report.
9. When insurance pays on the corrected procedure, enter as a supplemental payment.

If an incorrect procedure was submitted to insurance, insurance paid for the other procedures and requests a corrected claim for only the incorrect procedure.

1. Receive the original claim payment and mark the incorrect procedure as Received with $0 payment and $0 write-off.
2. Add a subtraction adjustment for amount of the incorrect procedure. Associate it with the incorrect procedure.
3. Chart and complete the correct procedure and backdate to the original date of service.
4. Create a new claim for the corrected procedure.
5. Send the new claim.

Incorrect Providers on Claim Procedures

If the claim is sent to insurance and then you realize the provider on the procedures is incorrect, we recommend calling the insurance carrier to see if this can be fixed over the phone, or if they require a corrected claim.

If you create a claim that has the wrong provider attached to procedures and have not sent it:

1. Delete the claim.
2. Edit the procedures to assign the correct providers.
3. Recreate the claim, then send it.

If you create a claim that has the wrong provider attached to procedures, send it, and then realize the error, or the insurance company denies the claim:

1. If necessary, create a Commlog entry in the affected patient account explaining why the payment was denied.
2. Open the claim and change its status to Waiting to Send.
3. Delete the claim.
4. Edit or delete the procedures to use the correct providers.
5. Recreate the claim, then send it.

If an incorrect provider on a procedure is submitted to insurance, insurance pays, and then is able to correct the provider over the phone:

If the procedure has already been marked received or to retain the original claim:

1. Commlog or notate on the claim that a corrected claim is necessary.
2. For the procedures assigned to the incorrect provider on the original claim, create an adjustment to adjust off the procedure amount. This zeroes out the procedure fee.
3. Chart the procedures with the correct provider for the original date of service.
4. Create a new claim with the corrected procedures and service dates.
5. If payment has been received for the procedures:
   1. On the original claim, create a negative supplemental insurance payment for any corrected procedures.
   2. Receive the insurance payment on the corrected claim.
   3. Claims can be finalized as a batch. Total payment amount will be zero.

If the procedure has not been marked received on the claim:

1. Double-click on the procedure and correct the Provider.
2. Double-click the claim procedure from the Insurance Estimates and Payments section of the Financial tab.
3. Edit the Provider on the claim procedure, if needed.
Note: If this is not allowed, disable Changing treating provider updates Claim Proc provider in Preferences.

Canada Users

In some cases, a claim can be reversed if edits need made on the same day the claim was sent. In these cases, reverse the claim, make the change, then send the claim again. For more information, see Canada Claims.