Receiving Claims

Receiving claims is the part of entering Insurance Claim Payments. Receiving a claim means entering payment amounts. Once received, finalize payments by attaching the received claims. See Finalizing Insurance Payments.

Follow the steps below to receive each claim on an EOB.

  1. In the Account Module, double click on the claim.
  2. Enter the insurance paid amounts. You have two options:
    • By Procedure (recommended): Itemize the payment by procedure. If the plan is a PPO, this is required so write-offs show properly in reports (Total will be disabled). If you choose this option the list of procedures will show (see below). Proceed to step 3.
    • Total: Enter a total payment amount. This will attach the amount to the claim, but not a specific procedure. On the Claim Procedure window enter the Insurance Paid amount and click OK. A line item for Total Payment will show in the Procedures grid. Proceed to Finalizing Insurance Payments.

    The Ins Pay amounts will automatically populate based on insurance estimate calculations. The Status will be Recd (received). The Totals at the bottom for deductible and insurance paid should exactly match the EOB.

  3. If needed, edit insurance payment information.
    • Fee: Fee billed to patient.
    • Ins Fee: Fee billed to insurance.
    • Deduct: Automatically calculated based on benefit information. Click in the cell to manually edit. To reassign a deductible to a different procedure, highlight the procedure, then click Deductible.
    • Allowed: Entered amounts will be saved to the out-of-network fee schedule for this insurance plan and used to calculate better estimates for patients with the same carrier. Out-of-network fee schedules can be automatically generated by the Blue Book.
    • Ins Pay: Automatically calculated based on benefit estimates. Click in the cell to edit.
    • Write-off: Automatically calculated. Click in the cell to edit or click Write Off in the lower left to create a write-off for all unpaid amounts by procedure (Fee Billed - Ins Pay).
    • Pay Tracking: Click in cell to select from a list of options (defined in Definitions: Claim Payment Tracking). Useful to track why payments are rejected.
    • Remarks: Click in the cell to enter remarks for any procedure that has a remark in the EOB.
    • Double click on Date, Prov, Code, Th, Description, Fee Billed or Status to open the Claim Procedures (claimprocs) and edit information.
  4. Click OK to save the procedure payment amounts. The claim status will change to Received.
  5. If entering a single claim, continue to Finalizing Insurance Payments.
  6. If entering a batch payment click OK to close the claim, select the next patient on the EOB, and continue steps 1 - 4 to receive other claims on the EOB. Once all claims are received, continue to Finalizing Insurance Payments.

Note: If you enter all the EOB information, including remarks, you can file the EOB and never have to refer to it again. All the information will be in Open Dental and accessible from any computer. If a patient asks why insurance did not pay as expected, you can quickly determine exactly which procedures were not paid and why. If primary insurance is not paid as estimated, secondary insurance estimates do not update.

Claims with No Payment

If no payment is made on a claim, you must still receive it. Simply enter 0 as the insurance payment amount (As Total or By Procedure). This will mark it as Received so it is no longer considered an outstanding claim.

To scan the EOB associated with the zero payment, finalize the payment as normal (enter 0 as the amount) then scan. See Scanning EOBs.

In the patient account, claims received with no payment show as follows: