Split Claim

In the Edit Claim window, click Split Claim in the upper right.

Splitting claims is useful if insurance only paid on some of the procedures in an Insurance Claim Payment, and you are still waiting on payment for the other procedures.

Then you can receive and enter payment for one claim, and the unpaid claim will remain outstanding.

Typical reasons to split a claim:

Scenario 1: Insurance rejects a claim due to missing information on one procedure. Split the rejected procedure into a new claim, then resubmit the original claim. Once information is updated for the rejected procedure, send with the split claim.

Scenario 2: Insurance decides to split one procedure from the claim because it will take longer to adjudicate. The EOB or ERA will indicate that the claim has been split. Manually split the procedure from the original claim. Since the procedure has already been submitted to insurance, it does not need to be resent.

  1. On the claim, highlight the procedures that are NOT included in the current payment.
  2. Click Split Claim. The procedures you received payment for should list under Procedures. The claims not included with the payment will be in a new claim.
  3. Receive the claim, then finalize the payment. See Receive Claim and Finalize Insurance Payment.

In the patient account there will be two claims: one received with a payment and one outstanding.

When you receive payment for the outstanding claim, receive the claim, then finalize the payment.

Troubleshooting

Message: Claim identifier already in use for another claim.

Prior to 15.3, the claim identifier on split claims was the same as the original claim. When a user attempted to send a split claim to insurance (scenario 1 above), this message displayed. To work around this, delete the split claim, then recreate (it will get a new claim identifier). Then send the new claim.

In version 15.3.25 and greater, split claims have a unique claim identifier. When notification of a split claim is received on an ERA (scenario 2 above) note that the claim identifier for both original and split claim on the ERA will be the same, even though the identifiers in Open Dental will be different. The difference will not affect matching of ERAs to claims because other criteria is used.