Receive Claim

In the Edit Claim window, at the upper right, is an Enter Payment area.

Click one of the three buttons.

When payments have been entered, paid procedures and the claim will change to a status of Received.

When entering payments, it is recommended to include all EOB information, including remarks. This way all information is available in Open Dental and accessible from any computer. When a patient has questions, you can quickly determine what was/wasn't paid and why.

Also see:

As Total

Entering payments As Total is available for insurance plans with a type of Category Percentage, Medicaid or Flat Co-pay, and Capitation.

Entering an As Total payment differs depending on the Account Module Preference for Claim Pay by Total splits automatically.

When Claim Pay by Total splits automatically is checked:

  1. Click As Total.
  2. Enter the total amount paid, then click OK.
  3. The Enter Payment window will open. Open Dental will automatically assign amounts to each procedure. Amounts can be changed if desired, or simply click OK to accept the amounts.
  4. The paid amounts will show split to each procedure in the Edit Claim window.
  5. Once complete, continue to Finalize Insurance Payment.

When Claim Pay by Total splits automatically is unchecked:

  1. Click As Total.
  2. The Edit Claim Procedure window will open. Enter the full Insurance Paid amount, then click OK.
  3. The total payment will show as a new line item in the Edit Claim window.
  4. Once complete, continue to Finalize Insurance Payment.

By Procedure

Entering payments By Procedure is available for all insurance plan types except Capitation. It is required for PPO plans to track write-offs.

  1. Click By Procedure.
  2. The Enter Payment window will open.

    If needed, edit insurance payment information, then click OK.
    • Fee: Fee billed to patient.
    • Billed to Ins: 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).
    • Pat Resp: Displays patient responsibility for the procedure. Only displays when enabled in Account Module Preferences
    • 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. Only displays when enabled in Account Module Preferences.
    • 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.
  3. Payments show associated with their procedures on the Edit Claim window.
  4. Once complete, continue to Finalize Insurance Payment.

Claims with No Payment

If insurance does not pay 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 Scan EOB.

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

Any remaining balance will be due by the patient. Take patient payments as normal.

Insurance Pays on Alternate Procedure Codes

If insurance pays on different procedure codes than you sent (e.g. You filed a BW and Pano, but insurance paid on FMX), simply add the payment to the procedures you charted. No need to recreate the claims or procedures.

  1. Enter the payment by Procedure.
  2. Allocate the payment to the procedures you actually performed.
  3. Add a note in the Remarks section.
  4. Finalize the payment as normal.