In the Edit Claim window, at the upper right, click Split Claim.
Splitting claims may be necessary if insurance only paid on some of the procedures in an Insurance Claim Payment, and the office is still waiting on payment for the other procedures or if some procedures need to be resubmitted, but not the entire claim.
Splitting the claim allows the office to receive payment for procedures that have been paid and leave unpaid procedures outstanding or resubmit them as needed.
There are some common scenarios an office may need to split a claim.
Scenario 1: Insurance rejects one or more procedures on a claim due to missing or incorrect information, but pays the rest of the claim. The rejected procedures need to be resubmitted to insurance.
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.
In both scenarios, in the patient account, there will be two claims: one received with a payment and one outstanding.
Any claim statuses from the original claim will be copied to the split claim. See Edit Claim - Status History Tab.
When payment is received for the outstanding claim, receive the claim and finalize payment.
Message: Claim identifier already in use for another claim.
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.