Canada Insurance Categories

For Canada users, in the Main Menu, click Setup, Family/Insurance, Insurance Categories.

Canadian insurance categories allow automatic calculations of insurance coverage based on the procedure code.

  • We do not recommend altering insurance categories. Changes affect benefit information for all Canada Insurance Plans.
  • The insurance categories above are the recommended setup for Canada.
  • If your spans contain Part A, Part B, Part C, and Endo, you can convert to the recommended setup. See Convert Four-Part Insurance Categories to Default Insurance Categories below.

Coverage Spans Grid: Displays the currently set categories and spans.

Categories: Coverage categories have specific procedure code spans attached according to typical insurance groupings. Categories are used to calculate the actual insurance coverage for specific procedures.

Add Span: Click to add a new coverage span. See Add Spans below.

Set to Defaults: Update existing spans in categories with an E-Benefit Categories assigned. The database must set to English (Canada). All E-Benefit Categories must be represented by an non-hidden Insurance Category in the list for the button to work.

Add Category

Click Add, or double-click a category row to edit.

Add Spans

Click Add Span, or double-click a coverage span row to edit.

From Code / To Code: Enter the procedure codes for the span. Open Dental warns users if the code is not in the correct CDA format (at least the first 5 digits), but the codes can still be used if needed.

Convert Four-Part Insurance Categories to Default Insurance Categories

Older Open Dental installations may be using a Four-Part setup. Follow these instructions to convert to the recommended setup.

  1. Rename Part C category to Ortho.
  2. Add new categories to match the recommended setup. Do not add Endo and Ortho because they already exist. Do not change Part A or Part B. For each new category, select the electronic benefit category and enter a default percentage.
    • The Category and E-Benefit Category must match exactly.
    • The default category percentages affect all patients. Do not change any default percentages from their old values unless certain they were wrong. Use the percentage values from Part A and Part B for reference.
  3. Reorder categories to match the recommended setup. Place Part A and Part B categories between General and Diagnostic. The first 4 categories must be in the following order:
    • General
    • Part A
    • Part B
    • Diagnostic
  4. Manually change the code spans for each category to match the recommended setup. Do not modify existing coverage spans for Part A or Part B.
  5. Hide the Part A and Part B categories.

The resulting insurance category spans will look like this:

As new insurance plans are added, they will only use the new insurance categories. Part A and Part B categories will not be used.

Existing insurance plans will continue to use the old insurance categories and percentages unless the plans are manually edited. To do so, we recommend changing insurance plan Benefit Information via the Insurance Plans (Lists, Insurance Plans) so all subscribers are affected by the change.