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How to Correct a Claim

Learn how to correct claims that have been created with incorrect procedures or providers by viewing an interactive guide or step-by-step instructions.

On this page:

Note:
  • 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.
  • If patient payments were allocated to the incorrect procedure, an Income Transfer may be necessary once the correct procedure is charted to properly allocate payment.

How to correct procedures or treatment area on a claim

Choose an option to jump to the applicable steps:

How to correct procedures or treatment area for a claim that has not been sent:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. In the Edit Claim window, click the Delete button.
  4. Click OK on the confirmation message.
  5. In the Patient Account grid, double-click each procedure that needs to be corrected.
  6. In the Procedure Info window, click the Delete button.
    • If correcting the treatment area, edit the procedure(s) instead of deleting.
  7. Click OK on the confirmation message to delete the procedure.
  8. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

How to correct procedures or treatment area for a claim that has been sent:

Choose an option to jump to the applicable steps:

To correct the claim and keep a historical copy:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. In the Edit Claim window, enter a claim note.
    • If only some procedures need to be resubmitted, split the claim and add the note in the new claim. See Split Claim.
  4. Click the By Procedure button.
  5. In the Enter Payment window, enter 0 in the Ins Pay column.
  6. Zero out any write-offs that were entered.
  7. Click Save.
  8. In the Edit Claim window, click Save.
  9. In the Patient Account grid, select the incorrect procedure(s) and right-click.
  10. In the menu, click Add Adjustment.
  11. The adjustment window opens:
  12. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  13. Select a Subtraction Type.
  14. Enter a note for the adjustment.
  15. Click Save.
  16. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

To correct the claim without keeping a historical copy:

  1. Select the patient and go to the Account Module.
  2. In the Main Toolbar, click Commlog.
  3. In the Communication Item window, select a Commlog Type.
  4. Enter details about why the claim is being resubmitted.
  5. Click Save.
  6. In the Patient Account grid, double-click the claim that needs to be corrected.
  7. In the Edit Claim window, click Delete.
    • If only some procedures need to be resubmitted, split the claim and delete the new claim. See Split Claim.
  8. Click OK on the confirmation window to continue.
  9. In the Patient Account grid, double-click the incorrect procedure(s).
  10. In the Procedure Info window, click Delete.
  11. Click OK on the confirmation window to continue.
  12. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

How to correct procedures or treatment area for a claim that has been denied:

Choose an option to jump to the applicable steps:

To retain a historical copy of the original claim:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. If the claim has already been received, skip to Step 7. If the claim has not been received, proceed with the following steps.
  4. In the Edit Claim window, click the By Procedure button.
  5. In the Enter Payment window, enter 0 in the Ins Pay column.
  6. Zero out any write-offs that were entered.
  7. Click Save.
  8. In the Edit Claim window, enter a claim note.
  9. Click Save.
  10. In the Patient Account grid, select the incorrect procedure(s) and right-click.
  11. In the menu, click Add Adjustment.
  12. The adjustment window opens:
  13. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  14. Select a Subtraction Type.
  15. Enter a note for the adjustment.
  16. Click Save.
  17. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

If you do not want to retain a historical copy of the claim and the claim was already marked as received:

  1. Select the patient and go to the Account Module.
  2. In the Main Toolbar, click Commlog.
  3. In the Communication Item window, select a Commlog Type.
  4. Enter details about why the claim is being resubmitted.
  5. Click Save.
  6. In the Patient Account grid, double-click the claim that needs to be corrected.
  7. Optional: In the Edit Claim window, click Split Claim if only some procedures need to be resubmitted. Open the claim with the procedures that need to be resubmitted.
  8. If the claim was attached to a check or batch when received, proceed with the following steps. Otherwise, skip to Step 23.
  9. In the Insurance Payments area, double-click the finalized payment.
  10. In the Insurance Payment (EOB) window, click the Edit button.
  11. In the Edit Insurance Payment window, edit the amount by .01.
  12. Click Save.
  13. Click OK on the confirmation message.
  14. Close the Insurance Payment (EOB) window.
  15. In the Edit Claim window, double-click the insurance payment again.
  16. In the claim you want to resubmit.
  17. Click Detach.
  18. Click OK on the confirmation message.
  19. Close the Insurance Payment (EOB) window.
  20. In the Edit Claim window, change the claim status to Not Received.
  21. Click the Delete button.
  22. Click OK on the confirmation message.
  23. In the Patient Account grid, double-click the incorrect procedure(s).
  24. In the Procedure Info window, click Delete.
  25. Click OK on the confirmation window to continue.
  26. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.
  27. Correct the batch payment. See Batch Insurance Payment for more details.

If you do not want to retain a historical copy of the claim and the claim has not been received:

  1. Select the patient and go to the Account Module.
  2. In the Main Toolbar, click Commlog.
  3. In the Communication Item window, select a Commlog Type.
  4. Enter details about why the claim is being resubmitted.
  5. Click Save.
  6. In the Patient Account grid, double-click the claim that needs to be corrected.
  7. Optional: In the Edit Claim window, click Split Claim if only some procedures need to be resubmitted. Open the claim with the procedures that need to be resubmitted..
  8. In the Edit Claim window, click Delete.
  9. Click OK on the confirmation window to continue.
  10. In the Patient Account grid, double-click the incorrect procedure(s).
  11. In the Procedure Info window, click Delete.
  12. Click OK on the confirmation window to continue.
  13. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

How to correct procedures or treatment area for a claim that has been paid by insurance:

Choose an option to jump to the applicable steps:

If insurance is requesting a corrected claim only:

  1. Select the patient and go to the Account Module.
  2. To add an adjustment to the procedure, in the Patient Account grid, right-click the incorrect procedure(s). Otherwise, skip to Step 9.
  3. In the menu, click Add Adjustment.
  4. The adjustment window opens:
  5. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  6. Select a Subtraction Type.
  7. Enter a note for the adjustment.
  8. Click Save.
  9. In the Patient Account grid, double-click the claim that needs to be corrected.
  10. In the Edit Claim window, enter a claim note.
    • If only some procedures need to be resubmitted, split the claim and add the note in the new claim. See Split Claim.
  11. Select the procedure(s) to be resubmitted.
  12. Click the Supplemental button.
  13. In the Enter Payment window, enter the amount insurance paid as a negative.
  14. If there were any write-offs entered, enter the amount as a negative.
  15. Click Save.
  16. In the Edit Claim window, click Save.
  17. Rechart the correct procedure(s) on the original date of service and send the corrected claim. See Edit Claim for more information.
  18. In the Patient Account grid, double-click the new claim to open it again.
  19. In the Edit Claim window, click the By Procedure button.
  20. In the Enter Payment window, enter the amount that insurance paid on the original procedure and any applicable write-offs.
  21. Click Save.
  22. In the Edit Claim window, click Batch to finalize the two claims together.
  23. In the Edit Insurance Payment window, the amount is 0. Click Save.
  24. In the Insurance Payment (EOB) window, scan the EOB if needed and click Save.

We recommend contacting insurance to discuss any potential refunds.

If insurance is requesting a refund only:

  1. Select the patient and go to the Account Module.
  2. To add an adjustment to the procedure, in the Patient Account grid, right-click the incorrect procedure(s). Otherwise, skip to Step 9.
  3. In the menu, click Add Adjustment.
  4. The adjustment window opens:
  5. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  6. Select a Subtraction Type.
  7. Enter a note for the adjustment.
  8. Click Save.
  9. In the Patient Account grid, double-click the claim that needs to be corrected.
  10. In the Edit Claim window, enter a claim note.
  11. Create an insurance refund for the procedure(s). See How to Create Refunds for more details.

If insurance is requesting a corrected claim and a refund:

  1. Select the patient and go to the Account Module.
  2. To add an adjustment to the procedure, in the Patient Account grid, right-click the incorrect procedure(s). Otherwise, skip to Step 9.
  3. In the menu, click Add Adjustment.
  4. The adjustment window opens:
  5. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  6. Select a Subtraction Type.
  7. Enter a note for the adjustment.
  8. Click Save.
  9. In the Patient Account grid, double-click the claim that needs to be corrected.
  10. Create an insurance refund for the procedure(s). See How to Create Refunds for more details.
  11. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

How to correct incorrect provider on a claim

Choose an option to jump to the applicable steps:

How to correct provider for a claim that has not been sent:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. In the Edit Claim window, click the Delete button.
  4. Click OK on the confirmation message.
  5. In the Patient Account grid, double-click each procedure that needs to be corrected.
  6. In the Procedure Info window, click the Delete button.
    • If correcting the treatment area, edit the procedure(s) instead of deleting.
  7. Click OK on the confirmation message to delete the procedure.
  8. Correct the provider on the applicable procedures and select in the Account Module.
  9. In the toolbar, click New Claim.
  10. In the Edit Claim window, click Save.

How to correct provider for a sent claim that cannot be corrected over the phone:

Choose an option to jump to the applicable steps:

If you want to retain a historical copy of the claim:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. In the Edit Claim window, enter a claim note.
    • If only some procedures need to be resubmitted, split the claim and add the note in the new claim. See Split Claim.
  4. Click By Procedure.
  5. In the Enter Payment window, enter 0 in the Ins Pay column.
  6. Zero out any write-offs that were entered.
  7. Click Save.
  8. In the Edit Claim window, click Save.
  9. In the Patient Account grid, select the incorrect procedure(s) and right-click.
  10. In the menu, click Add Adjustment.
  11. The adjustment window opens:
  12. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  13. Select a Subtraction Type.
  14. Enter a note for the adjustment.
  15. Click Save.
  16. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

If you do not want to retain a historical copy of the claim:

  1. Select the patient and go to the Account Module.
  2. In the Main Toolbar, click Commlog.
  3. In the Communication Item window, select a Commlog Type.
  4. Enter details about why the claim is being resubmitted.
  5. Click Save.
  6. In the Patient Account grid, double-click the claim that needs to be corrected.
  7. In the Edit Claim window, click Delete.
    • If only some procedures need to be resubmitted, split the claim and delete the new claim. See Split Claim.
  8. Click OK on the confirmation window to continue.
  9. Correct the provider on the procedure(s) and select in the Account Module.
  10. In the toolbar, click New Claim.
  11. In the Edit Claim window, send the claim or click Save to send it later.

How to correct provider for a sent claim that has been corrected over the phone:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the procedure that needs to be corrected.
  3. In the Procedure Info window, click the [...] button or use the dropdown to select the correct provider.
  4. Click Save.
  5. In the Patient Account grid, double-click the claim that needs to be corrected.
  6. If needed, click the [...] button or use the dropdown to update the treating provider as needed. Otherwise skip to the next step.
  7. Click Save.

How to correct provider for a paid claim that has been corrected over the phone:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. In the Edit Claim window, enter a claim note.
  4. Click the Supplemental button.
  5. In the Enter Payment window, enter the amount insurance paid as a negative.
  6. If there were any write-offs entered, enter the amount as a negative.
  7. Click Save.
  8. In the Edit Claim window, click Save.
  9. In the Patient Account grid, select the incorrect procedure(s) and right-click.
  10. In the menu, click Add Adjustment.
  11. The adjustment window opens:
  12. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  13. Select a Subtraction Type.
  14. Enter a note for the adjustment.
  15. Click Save.
  16. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.
  17. Enter payment amounts on the newly created claim. See How to Enter Insurance Payments for details.
    • When finalizing the claims, use the Batch button to receive the claims together. See Batch Insurance Payment for more details.

How to correct provider for a claim that has been denied:

Choose an option to jump to the applicable steps:

If you want to retain a historical copy of the claim:

  1. Select the patient and go to the Account Module.
  2. In the Patient Account grid, double-click the claim that needs to be corrected.
  3. In the Edit Claim window, enter a claim note.
    • If only some procedures need to be resubmitted, split the claim and add the note in the new claim. See Split Claim.
  4. Click the By Procedure button.
  5. In the Enter Payment window, enter 0 in the Ins Pay column.
  6. Zero out any write-offs that were entered.
  7. Click Save.
  8. In the Edit Claim window, click Save.
  9. In the Patient Account grid, select the incorrect procedure(s) and right-click.
  10. In the menu, click Add Adjustment.
  11. The adjustment window opens:
  12. Enter 100 as the percent for multiple procedures, or the full procedure fee as the amount for a single procedure.
  13. Select a Subtraction Type.
  14. Enter a note for the adjustment.
  15. Click Save.
  16. Rechart the correct procedure(s) on the original date of service and create a new claim. See Edit Claim for more information.

If you do not want to retain a historical copy of the claim:

  1. Select the patient and go to the Account Module.
  2. In the Main Toolbar, click Commlog.
  3. In the Communication Item window, select a Commlog Type.
  4. Enter details about why the claim is being resubmitted.
  5. Click Save.
  6. In the Patient Account grid, double-click the claim that needs to be corrected.
  7. In the Edit Claim window, click Delete.
    • If only some procedures need to be resubmitted, split the claim and delete the new claim. See Split Claim.
  8. Click OK on the confirmation window to continue.
  9. Correct the provider on the procedure(s) and select in the Account Module.
  10. In the toolbar, click New Claim.
  11. In the Edit Claim window, send the claim or click Save to send it later.

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.

Additional Resources

See our videos: Insurance Webinar Playlist.

See How to Enter Insurance Payments for detailed instructions on entering insurance payments.

See How to Create Refunds for detailed instructions on creating refunds.

Related Help Pages