Insurance claims are created after an appointment (and its attached procedures) has been set complete.
In the Account Module toolbar, select a New Claim option:
- To automatically create a claim for all procedures not billed to insurance without selecting any procedures, click New Claim. Claim Types are assigned based on the patient's insurance plan situation. If there is dual coverage, a secondary claim is automatically created with a status of Hold until Pri Received.
- For more control, highlight specific procedures, then click New Claim, or click the drop down to create a Primary, Secondary, Supplemental, or Other claim type.
On the Claim verify the claim information and change if necessary.
Send, print, or save the claim.
- Individual Claims: Preview, print or send an e-claim by clicking a button at the bottom of the Edit Claim window.
- Batch claims: It is common to leave the claim status as Waiting to Send and click OK. Then, at the end of the day, print or send all claims at once. See Send Batch Claims.
Note: When a patient has unearned income, the user will be prompted to allocate unearned income to completed procedures when creating the claim. See Allocate Unearned Income
Once created, the claim will show in the patient's account under the procedures. To edit, double click it.
- For information about secondary claims, see Secondary Insurance.
- If sending a secondary claim using ClaimConnect and NEA Fast Attach, any attachments (e.g. the EOB), need to be uploaded to NEA and documented in Open Dental before sending the claim. See Electronic Attachments.
- Claim text color is dependent on settings in Definitions: Account Colors.
- Printing a claim automatically changes its status to sent.
Questions and Answers
In what order are deductibles and annual max applied?
Deductibles and annual max are applied in the order that claims are created, not by procedure date.